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
 Mother's Full Name:    Father's Full Name:  
 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
Volleyball
Ice Skating
Softball
Squash
Golf (additional charge of $100 applies)
Tennis (additional charge of $200 applies)
Fencing (additional charge of $50 applies)
Flag Football
Floor Hockey
Nursery Sports
Exploring Adventure Program
E3 Sports Fitness(additional charge of $50 applies)
Check the Season(s) you wish to enroll in and note the cost information:
Spring 2010:
April 6 - June 4		 1 Day $720
2 Day $1368
3 Day $1998
4 Day $2592
5 Day $3150
Fall 2010:
Sept 13 - Dec 17		 1 Day $1080
2 Day $2052
3 Day $2997
4 Day $3888
5 Day $4590
Winter 2011:
Jan 3 - March 18		 1 Day $870
2 Day $1653
3 Day $2414
4 Day $3132
5 Day $3698
Spring 2011:
April 4 - June 3		 1 Day $720
2 Day $1368
3 Day $1998
4 Day $2592
5 Day $3150
Full Year 2010 - 2011:
September 13 - June 3		 $2475
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:
Helmet, gloves, stick, shoulder pads and arm pads
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.