2017 summer camp enrollment forms - srk after-school ... · pdf filethe sports camp of the...

Welcome Back!

SRK

CAMP 2017 SUMMER CAMP ENROLLMENT FORMS

Our 13th year of service to the Lutz area community!

SRK thanks YOU for the past WONDERFUL and FUN 16 years!

RATES:

✓ Five & Six year olds - $120 weekly

✓ Heritage Harbor Residents - $130 weekly

✓ Returning Summer Campers - $135 weekly

✓ Hillsborough County School Employees $135.00

✓ Regular rate $145.00 weekly

✓ Ask about Multi-child discounts ($10 off 2nd/3rd child)

✓ May not combine multi-discounts

RETURNING THIS YEAR: ADVENTURE CAMP WEEKS 4 & 8, Daily field trips: age 10+

SRK Camp Proudly Announces our 17th Year at Heritage Harbor!

2017 SRK Summer Camp Enrollment Forms

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Date: ________________ Parent’s Name’s: ___________________________________________________________________

Mom’s Cell _______________________ Dad’s Cell _______________________ Home Phone: ___________________________

How Many Children did you enroll? ___________________ Date you enrolled on line: __________________________________

Child’s Name: ______________________________ Childs Age when starting Summer Camp? ____________________________



*** EMAIL ADDRESS - You will be emailed invoices/statements please write clearly:

___________________________________________________________________________________________________________

You MUST Circle each week of summer camp that you are enrolling for:

(1) May 30 to June 2 (2) June 5 to 9 (3) June 12 to 16 (4) June 19 to 23 (5) June 26 to 30

(6) July 3 to 7 (7) July 10 to 14 (8) July 17 to 21 (9) July 24 to 28 (10) July 31 to Aug 4

Medical Information /Authorization: HEALTH HISTORY (Give approximate dates)

GENERAL ALLERGIES DISEASES

Ear Infections_________ Hay Fever__________ Chicken Pox__________

Rheumatic Fever_______ Ivy Poisoning________ Measles______________

Convulsions___________ Insect Stings_________ German Measles_______

Diabetes______________ Penicillin____________ Mumps_______________

Other drugs___________ Asthma_______________

Operations or serious injuries____________________________________________________________________

Chronic or recurring illnesses____________________________________________________________________

Other diseases or details of above_________________________________________________________________

Any specific activity restrictions? _________________________________________________________________

Doctor’s Name _______________________________________ Doctor’s Phone Number _____________________

Person to contact in case of emergency _____________________________________________________________

Allergies? ___________________________________________________ Medication? _______________________

Health Insurance Company:

Company______________________________________________ Policy Number___________________________

PARENT’S AUTHORIZATION: This health history is correct so far as I know, and the person herein described has permission to engage in all prescribed camp

activities, except as noted by me or a physician above.

In the event I cannot be reached in an EMERGENCY I hereby give permission to the physician selected by the camp director to

hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above.

Signature of Parent/Guardian_________________________________________________ Date_______________

Child’s Name __________________________ Age: _______________ School attending 2017/2018_______________


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Minimum

of Two Weeks

must be selected.

They do not have to be

consecutive.

Basic Fun Camp

8:45 AM to 4:30 PM

Camp rates:

5/6 yr olds $120

Returning Campers

$135

Heritage Harbor

Residents - $130

McKitrick Employees

$135

Regular Rate:

$145.00

Enter rate below

Extended Care

7:30 AM to

6:30 PM

Enter Rate

below of

$15.00 if

selecting

extended care

for the week.

Hot Lunch

Enter rate

below of

$30.00 if

buying Hot

Lunch for

the Week.

Sports/Activity

Camps Fee

Enter rate below

of $50.00 if

participating in

the sports camp

of the week!

Sports/Activity

Camps

Ages 7 and up!

Please Circle the

weeks if your child

will attend Sports

Camp.

Back by demand Adventure Weeks 4 & 8 Field Trips Mon

– Thurs

Beach,Movies etc

Ages (10) 5th Grade+

Rate is $225

Enrollment Fee $35.00 per child

enter here > $

Week 1 – May 30 to June 2 $ $ $ $ No Sport Camp

Week 2 – June 5 to June 9 $ $ $ $ Golf Camp

Week 3 – June 12 to June 16 $ $ $ $ Volleyball

Week 4 – June 19 to June 23 $ $ $ $ Adventure Week

Week 5- June 26 to June 30 $ $ $ $ No Sport Camp

Week 6 – July 3 to July 7 $ $ $ $

No Sport Camp

Week 7 – July 10 to July 14 $ $ $ $ Golf Camp

Week 8 – July 17 to July 21 $ $ $ $ Adventure Week

Week 9 – July 24 to July 28 $ $ $ $ Tennis

Week 10 – July 31 to Aug 4 $ $ $ $ No Sport Camp

Add the totals from top to bottom

and enter here, enter grand total

on the far right.

$

$

$

$

$


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Mail signed Enrollment forms along with minimum of $275.00 deposit per Child to:

This is Billing Address Only: SRK Camp 2746 Wilsky Rd. Land O’ Lakes FL 34639

Contact US: Stop by: Camp Location: 19502 Heritage Harbor Parkway, Lutz, FL 35588

Call: Robbie Cell Phone (813) 355-1720 E-mail: us at [email protected]

Mailing Address: 2746 Wilsky Rd, Land O Lakes, FL 34639 Website: www.srkcamp.com

SRK CAMP INFORMATION SHEET

Please read, sign and return with registration and payment!

Payments 1. SRK Camp offers payment plans; each Child’s Camp fees must be paid 2 weeks in advance of enrolled week.

2. Payments can be made weekly, bi-weekly or monthly.

3. Enrollment is easy, send in your enrollment forms with a 2 week’s deposit plus the $35 enrollment fee and you are all

set. ****If you wish, you may pay in full at any time.

4. Payment Options: Cash, check, money order or credit cards via our Paypal link on our website, please note there is a

3.5% processing fee for this option.

Cancellations/Discounts: 1. I understand that the weeks of enrollment I have selected are reserved for my child and other children may be turned

away. Any requests to change a reserved week, must be submitted to and approved by the Camp Director via email. I

understand that my request may not be granted due to space availability and unless my child’s spot can be filled a

refund/credit will not be issued.

2. Children registering for the full summer (all weeks –all summer) of camp will receive their final week of General Camp

free of charge (not to exceed the value of $150.00). Discount will be given at the end of summer and does not include

extended care, lunch or Sports Camp. If you cancel any week enrolled, the discount will be forfeited.

Hours of Operation 1. Standard Hours for camp are 9:00am to 4:30pm, with drop off at 8:45am. You may sign up for early drop off and late

pick up (7:30am – 6:30pm) for an additional $15.00 per week/per child.

Lunch/Field Trips/Sports Camps 1. SRK Camp offers the option of buying a weekly hot lunch package. The cost for prepaid lunch with tuition is $30.00

per week. You may purchase lunch by the day, the rate is $6.00 per day or you may send a lunch from home.

2. Field Trips will require additional fees, which include transportation. Payment and signed permission slips are required

in advance of scheduled field trip.

3. Sports camps are for ages 7 and up only. Hours are 8:00 am – 9:30 am. Children attending sports camp will join the

general SRK Camp at 9:30 for swim time, lunch, and the remainder of the camp day.

Waivers 1. I understand that my child’s photograph may be taken during his/her participation at SRK Camp and I give my

authorization for SRK Camp to display said photos in the classroom, our Facebook Page and on the SRK Camp website.

http://www.srkcamp.com/


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2. I grant permission for my child to ride in SRK Camp approved vehicles for daily transportation to and from field

trips, parks, game fields and other SRK Camp locations, etc.

PLEASE SIGN BELOW: Please enroll my child for the period specified on my enrollment form. I have read the above terms and conditions

describing SRK Camp, Inc. rules of operation and I hereby give permission for my child to participate in all SRK Camp

activities.

Date: _________Print Parents Name: ______________________Signature of Parent: __________________________

SRK Release of Liability

______________________________________________ I / We hereby RELEASE, WAIVE, DISCHARGE AND

COVENANT NOT TO SUE SRK Camp at Heritage Harbor, Heritage Harbor, and any and all employees from any

liability, claims, demands, actions, and causes whatsoever arising out of or related to any loss, damage or injury, including

death, that may be sustained by my child / legal ward, WHETHER CAUSED BY THE NEGLIGENCE OF THE

RELEASEE, or otherwise, while participating in athletic and camp activities, or while in, on or upon the premises where

the activities are being conducted or travel to and from SRK Camp at Heritage Harbor.

Name of Camper________________________________________ Date__________________

Signature of Parent / Guardian____________________________________________________

Heritage Harbor Community Development District/

Heritage Harbor Golf and Country Club Community Association, Inc.

Release of Liability In consideration of participation in and use of the recreational facilities and amenities located in and around the

Heritage Harbor Golf and Country Club facility (the “Recreational Facilities”), located at 19502 Heritage Harbor

Parkway, Lutz, Florida, parts of which are owned and/or operated by Heritage Harbor Golf and Country Club

Community Association, Inc. (“Community Association”) and the Heritage Harbor Community Development

District (the “HHCDD”), the undersigned for and on behalf of themselves and the minor child or children listed

below do hereby waive, exonerate, indemnify, release, and hold the HHCDD and the Community Association, and

their respective agents, directors, officers, and employees, harmless from and against all claims, liability, actions,

and causes of action, including, without limitation, costs and attorneys’ fees, for any loss or damage to personal

property or for personal injury which may arise from or in connection with use of the Recreational Facilities.

Nothing herein shall be construed as a waiver of the HHCDD’s sovereign immunity or limits of liability beyond any

statutory limited waiver of immunity or limits of liability, which may have been adopted by the Florida Legislature

in Section 768.28, Florida Statutes or other statute.

Name of Participant: ___________________________________________________________

Signature of Parent/Guardian: ___________________________________ Date: ____________

Signature of Witness: __________________________________________ Date: ____________

2017 summer camp enrollment forms - srk after-school ... · pdf filethe sports camp of the...

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