Summer Day Camp - LiveWell Athletic Club

26th
Ann
ual!
Summer Day Camp
June 6-August 12, 2016
Kids will love the great adventure that is LiveWell’s Summer Day Camp!
Perfect for working parents, LiveWell’s Day Camp provides quality care in a fun and
interactive atmosphere with experienced and highly qualified camp counselors.
No more couch potato summers!
Exciting activities including swimming, racquetball, tennis, wallyball, volleyball,
basketball, soccer, softball, creative games, arts & crafts, music, and
NEW this year Archery!
Also includes movies, fitness activities, field trips, and more!
Summer Day Camp operates for 10 weeks starting
June 6th through August 12th
for kids completed Kindergarten-6th grade.
Day Camp hours are 7:30 a.m. – 5:30 p.m.
Monday – Friday.
A camper may attend any week or any part of a week.
Director: James Craft
LiveWell Athletic Club * 1616 Tulane * Lufkin * Texas * 75901 * 936-639-5483 * www.livewellclub.com
Summer Day Camp
June 6-August 12, 2016
Summer Day Camp Fees
Summer Day Camp 2016 is a community service of LiveWell Athletic Club. The weekly fees and partial week fees are
paid in advance on the first morning of attendance for the week the camper plans to participate.
LiveWell Members
1 day =
2 days=
3 days=
4 days=
5 days=
$40
$55
$70
$80
$90
Non-Members
1 day=
2 days=
3 days=
4 days=
5 days=
$50
$65
$80
$90
$99
All prices are based on days within the same week. Camper will pay additional fees for some field trips.
$5 discount on weekly rate (only) for second and third child in the same family.
Lunches
Each child is expected to bring a sack lunch, plainly marked with the child’s name. No refrigerator
or microwave is available. If your child has a need for a special drink, please notify our director. Water is available,
water bottles are welcome.
Schedule
Day Camp hours are 7:30am-5:30pm, Monday-Friday. There will be a minimum fee of $10 or $1 per minute
(whichever is greater) assessed for children left after 5:35 pm or dropped off earlier that 7:25am. Each week
we will take special trips to locations in East Texas, such as Ellen Trout Zoo, Museum of East Texas, Lufkin Lanes,
Skate Ranch, Lufkin Mall Cinema, and many others.
Camp Registration
In addition to the weekly fee there is a one time summer registration fee of $49 per camper. This includes
registration, and a day camp T-shirt. Your child must be registered before June 30th to receive a camp T-shirt.
The $49 fee is due at the time of registration. We ask that you please pay all fees by check, credit card, or debit
card (No Cash) payable to LiveWell Athletic Club. Remember that all fees are non-refundable and nontransferable and there is a $25 fee for returned checks. In case of emergency- If you need to reach us, you can do
so by calling the LiveWell office at (936) 639-LIVE (5483).
Director: James Craft
LiveWell Athletic Club * 1616 Tulane * Lufkin * Texas * 75901 * 936-639-5483 * www.livewellclub.com
26th
Ann
ual!
2016 Day Camp Registration
June 6th-August 12th
A camper may attend any week or any part of a week. To enroll in camp, the registration fee
of $49 must accompany this form. Fees can be paid by check, credit card, or debit card.
Child’s name
Address
Age
Birthday
Male
Parent’s Name
Zip
Female
School Grade Completed
Cell Phone:
Business Name
Home Phone:
Business Address
Business Phone
Doctor
Doctor’s Phone
Date of Admission
School Name
Contact Information:
School Phone
Please circle which one you would prefer...
Email Address
Text Cell Phone#
T-shirt Size (please circle one)
Child's Small (6-8) Child’s Medium (10-12)
Child’s Large(13-16)
Adult Small(34-36) Adult Medium(38-40) Adult Large(40-42) Adult X-Large(44-46)
We do hereby release and discharge the Livewell Athletic Club of Lufkin, Texas and its authorized representatives
and staff from all liability of any kind and character upon any claim, demand, or cause of action.
I expressly acknowledge these paragraphs to be waiver and release of Livewell Athletic Club for any injuries or
harm incurred on its premises or a related activity sponsored by Live Well Athletic Club including aquatic
activities and trips.
Signature of Parent or Guardian
NOTE: Registration is complete when registration form, registration fee, and medical release are returned
to the LiveWell Athletic Club front desk. Fees can be paid by check, credit card, debit card, or money order.
There is a $25 fee for returned checks. All fees are non-refundable, and non transferable.
For Office Use Only
Reg Date
Amount Paid
Check No.
Member No.
Initials
2nd Child Discount
LiveWell Athletic Club
Summer Day Camp
**Day Camp Water Activities Participation Permission**
I, as the parent/legal guardian of __________________________________, give
permission for him/her to participate in all water activities LiveWell Day
Camp Schedules.
Parent Signature
Date
**Day Camp Transportation Permission**
I, as the parent/legal guardian of __________________________________, give
permission for transportation to and from designated field trips by LiveWell
Athletic Club.
Parent Signature
Date
**Day Camp Photograph Release**
I, as the parent/legal guardian of __________________________________, give
permission and consent for LiveWell Athletic Club to allow photographs to be taken
during camp session activities. I further give permission and consent that any such
photographs may be published and used by LiveWell Athletic Club and its agents,
to illustrate and promote the camp experience, LiveWell Athletic Club and its programs.
Parent Signature
Date
**Day Camp Pick Up Form**
I, as the parent/legal guardian of __________________________________, give
permission for the following adults to pick up my child at LiveWell Athletic
Club Summer Day Camp.
Parent Signature
Date
LiveWell Day Camp
Child Care Facility Health Record
Child’s Name
Age
Email
Date of Birth
School Attended
Male
Female
Grade Completed
Address
Mother’s Name
Cell Phone
Father’s Name
Cell Phone
Receive Txt? Yes or No
Receive Txt? Yes or No
Please list any allergies your child has:_____________________________________________
Please list any other medical conditions you would like us to be aware of :
________________________________________________________________________________
In case of emergency in which the parents cannot be reached please call:
Name
(1)
Relationship
Phone Number
(2)
In the event I cannot be reached or make arrangements for emergency medical attention at the time of
illness, I hereby authorize LiveWell Athletic Club to take my child to:
Name
Address
Phone Number
Hospital:
Doctor:
In the event of illness or accident on an out of town trip activity, I hereby authorize LiveWell Athletic Club
to take my child to the nearest emergency care facility for medical attention.
I do hereby release and discharge the LiveWell Athletic Club of Lufkin and its authorized representatives
and staff from all liability of any kind and character upon any claim, demand, or cause of action.
I expressly acknowledge these paragraphs to be a waiver and release of LiveWell Athletic Club for any
injuries or harm incurred on its premises or any related activity sponsored by LiveWell Athletic Club
including aquatic activities and trips.
Parent Signature
Date
2016 LiveWell Summer Day Camp
June 6th-August 12th
Please read this release form, sign and
return it with all other forms for registration.
Physical activity and children somtimes cause minor mishaps to occur.
Therefore, in the event a child sustains any injury, illness or other
physical harm in connection with being cared for in the LiveWell
child care area, I agree that neither the LiveWell Athletic Club nor any
of its child care employees, agents or principals shall be in any way
liable or held responsible for any claims, costs, liabilities, expenses or
judgements (including for example, doctor fees, hospital expenses and
personal injury claims) resulting from any such
injury, illness or physical harm.
Signature of Parent/Guardian
Printed Name of Parent/Guardian
Name of Child
Address of Child
Date