APPLICATION FOR CORBIN'S CRUSADERS SPORTS CLUB

APPLICATION FOR CORBIN'S CRUSADERS SPORTS CLUB
For School Vacation and Other Day Camp Please fill out Day Camp Application

CHILD INFORMATION

Childs Name: Gender: Male   Female

Age: Date of Birth: Grade:

Sibling #1 Name: Age:

Sibling #2 Name: Age:

Sibling #3 Name: Age:

FAMILY INFORMATION

Parent 1:

Parent 2:

House Street Address: Apt#:
Cross Street(s):
City: Zipcode:

Home Phone:
(xxx-xxx-xxxx) Cell Phone:
(xxx-xxx-xxxx)

Fax:
(xxx-xxx-xxxx) Business Phone:
(xxx-xxx-xxxx)

Email Address:

Business Address:
City: Zipcode:

EMERGENCY/MEDICAL INFORMATION

Emergency Contact: Emergency Phone:
(xxx-xxx-xxxx)

Family Doctor's Name:

Family Doctor's Phone:

Doctor's Address:
City: Zipcode:

Please add any important information about your child, such as medical or physical conditions (e.g., asthma) in the following area:

SCHOOL INFORMATION

School Name:

School Address:
Cross Street(s):

School Zipcode:

School Class: Teacher: Dismissal Time:

Name anyone other than parents who will be at your building for drop off and their relationship to you or check the following box if dropping off with the doorman is acceptable:
Drop my child off with Doorman

Greeter #1 Name: Relationship:

Greeter #2 Name: Relationship:

Greeter #3 Name: Relationship:

PROGRAM SELECTION

Please indicate the day(s)of the week to enroll: Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Check the Sports you wish to enroll in: Baseball
Soccer
Baseball/Soccer
Lacrosse
Basketball
Field Hockey
Volleyball
Softball
Flag Football
Floor Hockey
Nursery Sports
One on One Sports Instruction
Team Sports
Ice Skating
Golf (additional charge of $100 applies)
Tennis (additional charge of $200 applies)
Fencing (additional charge of $50 applies)
Exploring Adventure Program

Check the Season(s) you wish to enroll in and note the cost information:

Fall 2011:
Sept 12 - Dec 16 1 Day $1130
2 Day $2147
3 Day $3136
4 Day $4068
5 Day $4803

Winter 2012:
Jan 2 - March 16 1 Day $925
2 Day $1758
3 Day $2567
4 Day $3330
5 Day $3931

Spring 2012:
April 2 - June 1 1 Day $760
2 Day $1444
3 Day $2109
4 Day $2736
5 Day $3230

Full Year 2011 - 2012:
September 12 - June 1 $2599

CORBIN'S GEAR

Sweatshirt - $25

  Child:  Medium Large

  Adult:   Small   Medium   Large

Hat - $15

              Youth Adult

T-Shirt - $10

  Child:  Medium Large

  Adult:  Small Medium Large

Lacrosse Gear: For Boys: Helmet, gloves, stick, shoulder pads and arm pads required for program
For Girls - stick and mouthpiece only required for program

  Helmet - $110:

  Stick - $45:

  Gloves - $35:  Small  Medium  Large

  Shoulder Pads - $35:  Small  Medium  Large

  Arm Pads - $25:  Small  Medium  Large

Ice Skates:
Rental fee applies for 1 season.

Ice Skates Rental - $100:

Custom Cost:
( only if you have been told to fill in a custom cost )

If You Have Additional Questions or Comments, Enter Them Below..

SUBMIT APPLICATION

Once you have reviewed the above information,
press the submit button below to continue.

Cancellation Policy and Deposit Schedule:
A non-refundable 20% deposit is due with the application in order to secure a spot.
Payment in full is due one month prior to start of program, 50% of which is refundable
upon cancellation. After the first day of the program all fees are non-refundable.