Sample Camp Application Form printable pdf download

Appendix A

Sample Camp

Application

Your Camp Name Here Camp Application

Please print this form, fill out entire form, sign form, and mail it with deposit.

Be sure to also download and complete USA Ultimate Waiver AND the Medical form

Camper Information

Name: ___________________________________

Date of birth ________________________________

Address: _________________________________

City: ______________________________________

State _____________________________________

Zip: __________

Male

Female

Home Phone: ______________________________

Email address: ______________________________

Name of School: ___________________________

Grade in school as of 9-1-11 ___________

Are you a USA Ultimate member? Yes

Shirt Size _________

How did you hear about the camp? _____________

__________________________________________

_________________________________________

__________________________________________

Guardian Information

(if applicable)

Guardian One’s Name _______________________

Guardian Two’s Name ________________________

Guardian One’s Home phone _________________

Guardian Two’s Home phone ___________________

Guardian One’s Cell phone ___________________

Guardian Two’s Work phone ___________________

Guardian One’s Work phone __________________

Guardian Two’s Cell phone ____________________

In Case of Emergency Notify

Name: ___________________________________

Relationship: ________________________________

Address: _________________________________

City: ________________State: ____ Zip: _________

Phone: ___________________________________

Your camp dates and location(s) here

Discounts (optional)

Earlybird

Local organization membership

State organization membership

Sibling

Attended in past

Original cost $_______—Total discount $ ______ = Final cost $ _______

See rates and schedules link for discount info and which discounts can be combined.

Make checks payable to: Your camp name and send this application, the medical form, and the USA Ultimate waiver to :

Your camp name, camp address, city state, zip. A deposit (50% of tuition) will reserve your spot. Full tuition is due by June 15

or enrollment is subject to cancellation. Reservations are made in order of receipt, and we will notify you if preferred weeks

are not available. No refund will be made if notice of cancellation is not received 3 weeks prior to the weeks selected. We reserve

the right to dismiss any student whose conduct is detrimental to the camp and no refund will be made. No refund will be made for

late arrival or early departure. No refund will be made for withdrawal due to illness or family vacation. All cancellations subject

to $100 cancellation fee. Camp retains the right to use photographs of campers for advertising purposes unless a specific written

request to the contrary accompanies the application forms.

I HAVE CAREFULLY READ THE INFORMATION ABOVE AND AGREE TO THE CONDITIONS STATED HERIN.

Parent/Guardian Signature: ____________________________________ Date: __________________________

USA Ultimate Resource Guide

Sample Camp Application Form

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