Summer
LAKE MARY PREPARATORY SCHOOL
of
Fun 2015 JUly 20 ! 24 650 RANTOUL LANE LAKE MARY, FLORIDA 32746 407.805.0095 . WWW.LAKEMARYPREP.COM
Soccer Grade Level: 1ST – 8th (co-ed) Instructor: Tomasz Wilczak Dates: July 20 – 24 Times: 8:30 a.m. – 12:30 p.m. Cost: $195 Overview: The Lake Mary Prep Soccer Camp will be broken into sections based on age and skill level; therefore, it will provide a great atmosphere for beginners and more experienced players alike. In this fun-filled camp, Coach Wilczak will focus on several fundamentals including: passing, dribbling, striking, goalkeeping, and shooting. Awards will be handed out at the completion of camp.
CONTACT : Justin Varitek 407-805-0095 x 307 Justin.Varitek@lakemaryprep.com
Register below or online at www.lakemaryprep.com Summer Camp Registration Form *One form must be completed per child (two pages) Camper’s Name: _______________________________________________Age: ______ Grade: ______ Gender: _________ Mailing Address: ______________________________________________________________________________________ Parent and/or Guardian: __________________________________Relationship to camper: __________________________ Phone: ___________________ Email: _____________________________________________________________________ Parent and/or Guardian: ____________________________ Relationship to camper: ______________________________ Phone: ____________________________Email: _____________________________________________________________ Emergency contact person if the parent/guardian cannot be contacted: Emergency Contact: ____________________________ Relationship to student: ____________________________________ Is the emergency contact person authorized to pick up your child? ______yes______no. If no, please list the names and phone numbers of those authorized to pick up your child. 1._____________________________________________
2. ________________________________________________
Medical Information: List any allergies, diagnosed conditions, or emergency precautions that we should know for this child. This includes allergy triggers, diabetic reactions, seizures, etc. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ List all medications that are currently prescribed for this child. Include inhalers, EpiPens, etc. If medications are needed during camp hours, they must be sent in the original prescribed container and will be stored and administered by the school nurse. Your signature below gives permission for our nurse to administer these medications per instruction. All dosage information must be provided. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________
Parental/Guardian Consent, Acknowledgement, and Release 1. I hereby give consent for my child(ren) to participate in Summer Camp activities at Lake Mary Preparatory School and field trips provided by Lake Mary Preparatory School. 2. I know and acknowledge the risks involved in Summer Camp participation, understanding that injury is possible in such participation and choose to accept any and all responsibility for his/her own safety and welfare while participating in any Sumer Camp activity. I release and hold harmless LMP and LMP staff/instructors/volunteers of any responsibility and liability for any injury or claim resulting from such activity and agree to take no legal action against LMP or LMP staff/instructors/volunteers because of any accident or mishap involving the Summer Camp participation of my son/daughter. 3. I authorize emergency medical treatment for my child(ren) should the need arise for such treatment while my child(ren) is under the supervision of a Summer Camp instructor. I understand that if medical care is provided by a physician and/or hospital, these expenses will be my responsibility. 4. I understand if my child’s behavior is repeatedly disruptive or disrespectful, he/she will be dismissed without refund. 5. I grant LMP the right to photograph, videotape and otherwise record and use my child’s name and face in connection with publicity, advertising, and promotional materials without reservation or limitations whether now or hereafter developed. 6. There are NO refunds once a payment has been made towards a camp.
I HEREBY UNDERSTAND AND HAVE READ THE ABOVE INFORMATION AND AGREE TO ABIDE BY ALL SET FORTH IN THIS DOCUMENT. Name of parent/guardian (Print) ________________________________________________________________ Signature of parent/guardian: ______________________________________________Date: ________________
Register below or online at www.lakemaryprep.com
Summer Camp Enrollment Form Camper’s Full Name: ______________________________________________________________________________________ T-Shirt size: __ Y x-sm __ Y sm __ Y med __ Y lg __ Y x-lg__ A sm __ A med __A lg __A xlg __A 2xlg Please select the camps your child will be participating in:
Day Camp (Age group Pre-K 3 – 5th grade): ____ Week 1: June 1-5 Tropical Paradise ____ Week 6: July 6 – 10 Mission to Mars ____ Week 7: July 13 -17 Animal Planet ____ Week 2: June 8- 12 Backyard & Beyond ____ Week 3: June 15 – 19 Spy Kids ____ Week 8: July 20 – 24 Wizards & Mythological Creatures ____ Week 4: June 22 – 26 Medieval Times ____ Week 9: July 27 -31 Imaginarium ____ Week 5: June 29 – July 3 Party in the U.S.A. ____ Week 10: August 3-7 Water Exploration *Please see the Day Camp section for pricing, camp hours, and half-day options.
Academic Camps (Pre-K 3yrs– 12th grade): ____ Writing Camp June 15 – 19 (1st – 3rd grade) 8:30 a.m. – 12:30 p.m. ($195) ____ Writing Camp June 22 – 26 (4th – 6th grade) 8:30 a.m. – 12:30 p.m. ($195) ____ Middle School Organizational & Study Skills July 20 - 24 (6th - 8th grade) 8:30 a.m. - 12:30 p.m. ($195) ____ Geometry Summer Course June 1 – 26 (9th – 12th grade) week 1:12:30 a.m. – 3:30 p.m. week 2 - 4: 8:30 a.m. – 12 p.m. ($1500) ____ Singapore Math June 1 – 5 (2nd – 3rd grade) 8:30 a.m. – 12:30 p.m. ($195) ____ Singapore Math June 8 – 12 (4th – 6th grade) 8:30 a.m. – 12:30 p.m. ($195) ____ Algebra II Summer Course June 9 – July 3 (10th – 12th grade) 8:30 a.m. – 12:30 p.m. ($1500) ____ Junior Science Club July 6 - 10 (Pre-K3 – 1st grade) 8:30 a.m. – 12:30 p.m. ($195) ____ The Reading Connection June 8 – 12 (K – 2nd grade) 8:30 a.m. – 12:30 p.m. ($195) ____ Preview to Preschool July 27 – 31 (Pre-K3 – Pre-K4) 8:30 a.m. – 12:30 p.m. ($195) ____ Creative Writing Middle School June 15 - 19 (6th – 8th grade) 8:30 a.m. – 12:30 p.m. ($195) ____ Experimental Cuisine June 15 – 19 (6th – 8th grade) 9:00 a.m. – 12:30 p.m. ($195) ____ S.T.E.M. stands for Fun July 13 – 17 (6th – 8th grade) 9:00 a.m. – 12:30 p.m. ($195)
Griffin Athletic Camps (K – 8th grade): ____Girls Volleyball June 8 – 12 (3rd – 8th grade) 8:30 a.m. – 12:30 p.m. ($195) ____Baseball June 8 – 12 (1st – 8th grade) 8:30 a.m. – 12:30 p.m. ($195) ____Baseball August 3 – 7 (1st – 8th grade) 8:30 a.m. – 12:30 p.m. ($195) ____Golf June 15 – 19 (1st – 8th grade) 8:30 a.m. – 12:30 p.m. ($195) ____Lacrosse June 15 – 19 (1st – 8th grade) 8:30 a.m. – 12:30 p.m. ($195) ____Cheer, Dance & Tumble June 22 – 26 (K – 5th grade) 8:30 a.m. – 12:30 p.m. ($195) ____Basketball July 13 – 17 (1st – 8th grade) 8:30 a.m. – 12:30 p.m. ($195) ____Soccer July 20 – 24 (1st – 8th grade) 8:30 a.m. – 12:30 p.m. ($195) ____Football July 27 – 31 (1st – 8th grade) 8:30 a.m. – 12:30 p.m. ($195)
Specialty Camps: *Registration is done directly with the vendor. Please see the specialty camp section for more information.
Total payment: ______________ Cash _________ Money Order: ______Check _________Check number ________ Parent/ Guardian Signature: _______________________________________________ Date submitted: _________ Payment is due prior to the week that your child attends camp. Please return registration and payment to either the US or LS front desk. Checks can be made payable to Lake Mary Preparatory School.