Conte S Palm-Aire Golf Academy2016 Junior Summer Golf Camp Application

CONTE’S PALM-AIRE GOLF ACADEMY 2016 JUNIOR SUMMER GOLF CAMP APPLICATION

Camper Personal Data

NAME (LAST) (FIRST)

(Name by which camper would like to be addressed (i.e. Mike, Michael): ______

ADDRESS

CITY/STATE/ZIP COUNTRY

PHONE ( ) E-MAIL ADDRESS

SEX [ ] M [ ] F DATE OF BIRTH (MM/DD/YY) AGE AT CAMP

NAME OF SCHOOL GRADE AS OF SEPTEMBER 2016

WHERE/HOW DID YOU HEAR ABOUT US?

Parent/Guardian Information

FATHER’S NAME MOTHER’S NAME

ADDRESS ADDRESS

CITY/STATE/ZIP CITY/STATE/ZIP

PHONE HOME/WORK PHONE HOME/WORK

PHONE CELL/PAGER PHONE CELL/PAGER

I would like to register my child for the following week(s): Full Day - Half Day - PeeWee

[ ] Week 1 June 13 – 17, 2016 [ ] Week 4 July 4 – 8, 2016 [ ] Week 7 July 25 – 29, 2016 [ ] Week 2 June 20– 24, 2016 [ ] Week 5 July 11 – 15, 2016 [ ] Week 8 Aug 1 –Aug 5 2016

[ ] Week 3 June 27 – July 1, 2016 [ ] Week 6 July18 –22, 2016

Camp space is limited and applications with payment must be completed in full and received prior to camp date.

1 CONTE’S PALM-AIRE GOLF ACADEMY 2016 JUNIOR SUMMER GOLF CAMP APPLICATION

Payment of Fees

Junior Campers -ages 8 – 16 Standard camp tuition: $325 per week / per child Monday-Friday 9a.m. to 3 p.m. Early Registration (Before May 15, 2016): $265 per week / per child if pre-paid before May 15, 2016

Half Day Camp tuition: $225 per week/per child Monday-Friday 9a.m. to 12p.m. These camps include daily golf instruction, range balls, daily golf fees (weather permitting), snacks and a Pizza lunch on Fridays.(Jr.Campers should bring packed lunch Mondays thru Thursdays.)

Pee Wee Campers (ages 4 – 7 ) Standard camp tuition: $125 per week / per child. Tues - Wed -Thurs 9a.m. to 12p.m.

This camp includes daily golf instruction, range balls and daily golf fees (weather permitting) and snacks.

Discounts: A 10% discount per child off camp fees may apply provided said child (children) meets one of the following discount criteria:

 Two (2) or more children in the same family attending camp, or  Pre-payment / registration for two (2) or more weeks of camp (pee wee not eligible)  Children / Grandchildren of current Palm-Aire Country Club Members, or  Current students are participating school partners.

*Maximum discount is 10%; discounts are not cumulative and cannot be applied to Continued Care. Discounts are applied to each prepaid child attending a full week of camp only. Discounts cannot be retroactively refunded.

Registration: All camp payments and completed applications for the following week are due at least 7 days in advance. Acceptable forms of payment include Visa, MasterCard, Discover, cash and local check (There is a $30 charge for any returned checks that fail to clear).

Refund/cancellation policy: Notification of withdrawal must be made in writing to the camp. There will be a full refund of all moneys paid if notice of cancellation is given 14 days or more prior to the first day of camp. There will be a 50% refund of all moneys paid if notice of cancellation is given 7 to 13 days prior to the first day of camp. There will be NO refund if notice of cancellation is given less than 7 days prior to the first day of camp. There will be no refund for a student who is asked to leave for the use of drugs or alcohol, non-notification of a serious medical condition, or whose conduct is detrimental to the camp, (these decisions are the sole discretion of Camp). No refund will be made for late arrival or early departure or withdrawal due to illness or family vacation.

Camp Hours of Operation

Pee Wee Golfers (ages 4 – 7): 9:00 a.m. to 12 noon. Junior Golfers (ages 8 to 16): 9:00 a.m. to 3:00 p.m.

Camp Headquarters is located in The Oaks Clubhouse 3701 Oaks Clubhouse Drive. This area will serve as the primary area of many camp activities, including drop-off and pick up.

Camp Starts at 9:00 a.m. for all campers. Camp doors open daily at 8:45 a.m. There is no adult supervision before this time so for the safety of your child, do not “drop off” or leave your child without registering them for the day with an adult camp representative.

Camp Ends at 12 noon for Pee Wee Golfers (ages 4 to 7) and at 3:00 p.m. for Junior Golfers (ages 8 to 16).

Late Fees: Camp reserves the right to charge a $20 late fee per occurrence for any child who is picked up by an authorized parent or guardian more than 30 minutes after the end of camp. (Camp ends for Pee Wee Golfers at 12 noon so any pick-up after 12:30 p.m. would be considered late. Camp ends for Junior Golfers at 3:00 p.m. so any pick-up after 3:30 p.m. would be considered late.

Daily Sign-in / Sign-Out: All campers are required to be signed in and out by an authorized parent or guardian every day. Proper identification and written permission from a parent or guardian is required before any student is permitted off property. Following is a list of authorized person(s) other than parent/guardian to pick up my child (children) from camp:

*NAME RELATIONSHIP PHONE CELL/BPR.

*Photo identification is required from all person(s) authorized to pick-up campers (including parent or guardian).

Visiting\Pick-Up: Parents and guests are welcome to visit at any time during camp hours. For drop-off & pick-up, parents or guardians MUST sign in and out each day.

Proxy Dismissal Consent: Parents or guardians of campers who walk or ride bikes to camp must complete a Proxy Dismissal Consent Form (See page 7) in order to sign-in and out of camp without an adult signature during eligible drop off / pick-up times.

Items to Bring: Campers should bring the following items to camp on a daily basis: sunscreen, hat/cap, sneakers, golf shoes (optional), golf clubs and snacks (other than those provided by Camp).

Lunch: Junior Campers (ages 8 to 16) should bring a packed lunch to camp every day, preferably in an insulated cooler or bag. The Country Club has a restaurant where campers can purchase lunch off of the menu also. On Friday “PIZZA DAYS”, pizza will be provided to all Junior Campers at no additional charge. [Note: Pizza lunch is not included in Pee Wee Campers (ages 4-7).]

Camp Rules: Students are not permitted to smoke while in the program. Alcoholic beverages and illegal substances of any type are forbidden. Gambling is not permitted at camp. Profane language is prohibited. We will not be responsible for any electronics or cell phones that may be lost or misplaced.

Parents will be notified of any infraction of camp rules. The camp reserves the right to dismiss and send home participants whose conduct is deemed detrimental to the camp. Camp policy is not to refund the tuition of any camper sent home under these circumstances.

Photos: The Camp retains the right to use photographs of this camper for advertising purposes.

Parent/Guardian Agreement: I have read the application and give my permission for my son/daughter to participate in the Conte’s Palm-Aire Golf Academy Junior Summer Golf Camp. I agree that my son/daughter will abide by the rules and regulations of the program, and I realize that any breach of these rules may result in his/her immediate dismissal without refund of any fees. I authorize The Camp, or its authorized representatives, to take whatever action it may consider to be warranted under the circumstances regarding my child’s health and safety, and I fully release The Camp and its authorized representatives from any liability for such circumstances or actions as may be taken in connection therewith. I authorize The Camp, or its authorized representatives, at its discretion in an emergency situation, to place my child, at my own expense and without further consent, in a hospital for medical services and treatment, or if no hospital is readily available, to place my child in the hands of a licensed doctor for treatment.

PARENT/GUARDIAN SIGNATURE DATE ______

Participant’s Agreement: I agree to abide by the rules of the Summer Camp Program. I understand that the camp has the right to dismiss me and return me to my parent/guardian, without refund, if I violate camp rules.

SIGNATURE OF CAMPER DATE ______

Conduct

I understand that by enrolling in the Conte’s Palm-Aire Golf Academy 2016 Junior Summer Golf Camp, I am expected to obey the rules and regulations of Palm-Aire Country Club and to conduct myself as a responsible golfer. If I do not conduct myself responsibly, my golfing privileges will be revoked and my lessons discontinued without refund.

Liability Waiver

I understand that the sport of golf involves certain potential risks. In consideration of my acceptance into this summer camp program, I hereby release any and all rights and claims for damage against the Conte’s Palm-Aire Golf Academy, Palm Aire Country Club, their agents, their professional staff and any instructors or volunteers. Also, the Conte’s Palm-Aire Golf Academy has my permission to render any necessary first aid treatment to my child while in attendance at the camp program and activities. Conte’s Palm Aire Golf Academy is not responsible for any lost or stolen equipment, electronics or other personal items that your camper chooses to bring to camp.

______Name of Parent / Guardian Name of Camper Date

______Signature of Parent / Guardian Signature of Camper

Note: When weather is questionable, please call the Conte’s Palm-Aire Golf Academy (954) 971-7867 before transporting children to course. We will have some indoor options and activities. There will be no make-up dates or refunds unless Conte’s Palm Aire Golf Academy has canceled a class.

CAMPER HEALTH HISTORY FORM Please complete the Health Information / Emergency Contact below, which must be signed by a parent or guardian. This form is to be returned to our office one week prior to the start of the camper’s first session.

The Conte’s Palm-Aire Golf Academy Junior Summer Golf Camp requires a complete medical examination of each camper prior to registration. Please identify a friend or relative as an emergency contact in the event you cannot be reached and your child requires medical attention.

NAME BIRTH DATE SEX AGE

PARENT OR GUARDIAN

HOME ADDRESS PHONE

BUSINESS ADDRESS PHONE

SECOND PARENT OR GUARDIAN/EMERGENCY CONTACT

HOME ADDRESS PHONE

BUSINESS ADDRESS PHONE

IF NOT AVAILABLE IN AN EMERGENCY, NOTIFY:

NAME RELATIONSHIP:

ADDRESS PHONE

PRIMARY PHYSICIAN PHONE:

HEALTH INFORMATION: Please list any known allergies and any other special medical issues that the camp should be aware of . . .

______

Emergency Authorization: I hereby give permission to the medical personnel selected by the camp director to order X-rays, routine tests and treatment for my child, and 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 and/or anesthesia and/or surgery for my child as named above. This form may be photocopied for use out of camp.

SIGNATURE OF PARENT OR GUARDIAN DATE

WITNESS DATE