SYCAMORE SWIM CAMPS

SYCAMORE FOUR-DAY SWIM CAMP

June 5-8, 2017

CAMP COSTS

$350 + registration fee* 

CAMP DETAILS

- Open to Boys and Girls Ages 8+ to graduating seniors
- Camp runs from 8 a.m. - 5 p.m. each day

FOR REGISTRATION INFORMATION/INQUIRIES:

- E-Mail: For Further Information!
- Register On-Line: Now Available!

All Camps open to any and all entrants, limited only by number and age

* Add 6% convenience fee for on-line registrations

Thank You to Our Sponsors!




2017 SYCAMORE SWIM CAMP REGISTRATION - JUNE 5-8, 2017


Registration Note - Space is limited so we encourage campers to register as soon as possible. All monies, less a $75 non-refundable administrative fee, will be refunded for cancellations made before May 22. Cancellations from May 22 until the start of camp will be refunded (minus the administrative fee) for medical purposes only and must be accompanied by a physician's letter of explanation prior to the start of camp. No refunds or cancellations after the start of camp for any reason.  

Camper's Name (Last, First)*
 
Home Address*
 
City*
 
State*
 
Zip*
 
Parent/Guardian Name(s)*
 
Camper's Home Phone #*
 
Parent's Cell Phone #*
 
Parent's E-Mail Address*
 
Age (as of June 5, 2017)*
 
T-Shirt Size*
 Youth-S
 Youth-M
 Youth-L
 Adult-S
 Adult-M
 Adult-L
 Adult-XL
 
High School Graduation Year (i.e. 2021)*
 
Birthdate (Month/Day/Year)*
 
Gender*
 Female
 Male
 
Name of Club Team
 
Club Team Coach's Name
 
Do you have a USA Swimming Registration Card?*
 

If you do have a USA Swimming Swimming or YMCA Card, please bring a copy of it with you to registration
 
Best Time (in yards): 50 Free (i.e. :35.0)
 
Best Time (in yards): 100 Free (i.e. 1:10.0)
 
MEDICAL CONSENT FORM
In order to enable Indiana State medical facilities and/or other health facilities in Terre Haute to provide prompt care to your minor son or daughter, please read and complete the below consent form. This way we can help your child without delay should an emergency occur.  

Name of Minor*
 
Insurance Company*
 
Policy Number/Group #*
 
Name of Policy Holder*
 
Allergies/Allergic Reactions
 
Present Medication (include dosage)
 
Date of Last Tetanus Toxoid
 
Any past or present illness, or injury or other information that would be useful in the event that treatment is needed
 
Name and # to call if parent can't be reached*
 

*  I grant permission to the director, assistants, or other persons responsible for said minor to act on my behalf for said minor in granting permission for evaluation and treatment of medical problems. I understand that should a major medical problem arise, an attempt will be made to notify me by telephone. In the event that I cannot be reached, I hereby give my consent to such treatment as deemed necessary (including surgery, x-ray examinations, and anesthesia to be rendered to said minor by a licensed physician or nurse)  

* I do herby, waive, release and discharge the Sycamore Swim Camp, Forward Marketing LLC and respective staffs, employees, successors and assigns,of and from any and all rights and claims for damage resulting from injury of my person or property, which may be or arising out of my travelling to or from the Sycamore Swim Camp. I/we, the parents/guardians, agree to the above waiver and release and we join therein.  

* By my submission of this registration, I represent that I am either 18 years of age or older, or that I am the parent or legal guardian of the registrant (if he/she is under age 18).  

Parent/Guardian Name*
 
Date*
 

PAYMENT OPTIONS
Please select your payment option by indicating a '1' in the quantity field.
We need a registration form and consents completed for each participant.

Note: A charge from Hoosier Sports Camps will appear on your credit card for your on-line registration. However, if any of the Sycamore Swim Camps are canceled for any reason, refunds must be collected directly from the Sycamore Swim Camp.
 
Qty 
 $371.00 Option 1 - Individual Registration - Four-Day Rate

 $185.50 Option 2 - Individual Registration - Two-Day Rate

 $92.75 Option 3 - Individual Registration - Single-Day Rate