DELAWARE VALLEY GYMNASTICS ACADEMY

A Junior Olympic Training Facility for Future Stars...Now under NEW Ownership!

3011 Philmont Avenue Huntingdon Valley, PA 19006 215.938.0900 Summer Camp Application and Release Form Printable Version APPLICATION FORM Summer 2008 Child’s Name___________________________________ Birth Date_______________ Age_____ Address_______________________________________ City__________________ Zip________ Home Phone_______________________ Mom (work)_______________________ Mom (cell)_______________________ Dad (work) _______________________ Dad (cell)________________________ Emergency Contact: Name________________________________________ Relationship_______________________ Home Phone_______________________ Cell #____________________________ CAMPS: Girls & Boys - Please check week(s) and Camp. ( ) FULL DAY CAMP ( ) HALF DAY CAMP ( ) PRESCHOOL CAMP ( ) June 23 – 27 ( ) June 30 – July 3 ( ) July 7 – July 11 ( ) July 14 – July 18 ( ) July 21 – July 25 ( ) July 28 – Aug 1 ( ) Aug 4 – Aug 8 ( ) Aug 11 – Aug 15 CLASSES: Tuesday or Thursday - Check Day and Time                                               TUE  TH Tiny Tots .5:00 – 6:00     ( )   ( ) Girls Beg .4:00 – 5:00     ( )   ( ) Girls Int/Adv ...5:00 – 6:00  ( )   ( ) Boys Classes 5:00 – 6:00  ( )   ( ) Delaware Valley Gymnastics Academy 3011 Philmont Avenue, Huntingdon Valley, PA 19006 (215) 938-0900 2008 SUMMER CAMP & CLASSES RELEASE STATEMENT I (we) the undersigned student or legal guardian of a student for Delaware Valley Gymnastics Academy, Inc. for and in consideration of the enrollment of my child or a student for whom I have been granted legal custody hereby voluntarily and knowingly, execute this release with the expressed intention of effecting the extinguishments of and complete release from any and all claims, actions, demands or rights monetary judgement arising from any injury or physical harm which may arise from or be sustained as a result of the participation, practice and physical activity associated with the gymnastics, camp and related activities conducted by Delaware Valley Gymnastics Academy, Inc. Should transportation be required, my child and/or legal ward has permission to use camp transportation and I hold harmless Delaware Valley Gymnastics Academy Inc., teachers and staff from any and all injuries during camp. By the execution hereof I do further bind myself, my child, my legal ward, their heirs, executors, administrators, successors or assigns. EXECUTED THIS DAY_______________________ ____________________________________________ Signature of Parent/Legal Guardian Proud member of USA Gymnastics