School's Out CAMP NOMAD
Join us for CAMP NOMAD! We keep the kids entertained and busy with all sorts of fun activities like kids karate, yoga, swimming (with instruction time), arts and crafts, outdoor sports AND MORE! This year we have added before/aftercare and a bus pick-up option for your convenience. Please submit one form per child.
Email address *
Schedule & Pricing
How did you hear about Study Buddies AFTER SCHOOL @ NOMAD? *
Child's Gender *
FIRST NAME (Child) *
LAST NAME (Child) *
Child's date of birth *
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Grade & School Attending *
Choose your Days (complete each row) *
NO
AM HALF DAY 8:30a-1:00p
PM HALF DAY 12:00p-4:30p
FULL DAY 8:30a-4:30p
EARLY 7:30a Drop-Off $10
LATE 5:30p Pick-Up $10
BOTH 7:30a & 5:30p $15
JAN 18 WED
FEB 15 MON
APR 2 FRI
APR 5 MON
APR 6 TUE
APR 7 WED
APR 8 THU
APR 9 FRI
BUS TRANSPORTATION AVAILABLE: Are you interested in pick-up between 7a-8a ($12 per day or $50 "bus pass" through Feb/Presidents' Day) from:
Clear selection
Parent/Guardian First and Last Name *
Parent/Guardian Street Address *
Parent/Guardian Contact Phone Number(s) *
Additional Parent email (optional)
Emergency Contact First and Last Name *
Emergency Contact Contact Number *
Emergency Contact Relationship to Camper *
Please list those people in addition to Parent/Guardian that are permitted to pick up your camper and their phone number and email address:
Please tell us a little about your campers swim experience and ability level. *
Medical Information: Name of Insurance Provider & Policy Number *
Medical Information: Primary Physician *
Please list ANY allergies that your camper has to any food, medications or environmental factors.
Please list and describe any health issues, medical conditions and/or physical concerns, as well as, any current medications.
Please list anything else you would like us to know about your child.
Terms of Agreement: NOMAD Aquatics & Fitness and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness with accompanying physician's note. Children's photos and quotes may be used for publicity purposes, In case of an emergency, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or physician). Please initial below. *
Photo Release: I hereby give permission for my child to be photographed at NOMAD Aquatics & Fitness. I understand the photos will be used for promotional purposes. I understand that although my child's photograph may be used for advertising, his or her identity will not be disclosed. I do not expect compensation and that all photos are property of NOMAD Aquatics & Fitness and its affiliates. Please initial below. *
Guardian Signature *
$25 Registration Due - covers 1 year of programs (camps & lessons) *
$20 Deposit Due - for each day selected *
Payment Options: *
None
Registration Fee and/or Deposit (at Registration)
Balance Due for Camp (2 days prior to start)
Credit Card + 3% Convenience Fee
ACH Draft
Check (must be received by 2 days prior to camp start or it will be auto-drafted by method of payment provided)
Enter Method of Payment (ACH - Bank Name, Routing, and Account number OR CC info with date of expiration and CVV code). If entered for another child, please type "provided". *
I authorize NOMAD Aquatics & Fitness to draft my CC or make an ACH DRAFT for a registration fee (if due) and camp deposit ($20 per day) that is not refundable. The balance will be due 2 days prior to camp start and will be automatically drafted by the method selected above if a check is not presented before that time.
Printed Name of Parent/Guardian *
Date Submitted *
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A copy of your responses will be emailed to the address you provided.
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