Orchard Lake Schools Summer Camps
FULL MEDICAL AUTHORIZATION AND RELEASE
Campers Name Camp
Please understand that there are certain medical risks involved in camping activities, and especially in sports. I have discussed them with my child and want my child to fully participate in this Summer Program. An athletic trainer will be available during the camp sessions, and the infirmary facilities of St. Mary’s will be available in the event of injury to a camper. To permit treatment of injuries, the following authorization must be signed and dated.
In case of an emergency, I hereby give permission for my child
to be examined and treated by the camp trainer. I also give permission to any licensed physician selected by the camp operator to hospitalize, secure proper treatment, anesthesia or surgery for my child in an emergency. Any health care provider or facility is authorized to release any information to St. Mary’s or the family physician as may be necessary.
Signature of Parent or Legal Guardian
Name (Printed) of Parent or Legal Guardian
Address State Zip
Home Phone Cell/Work
Medical Insurance Policy Number
Health Problems/Allergies/Previous Surgeries
In the event of an emergency and the parents are unable to be reached, please contact:
Name Phone/Cell
Family Physician Name
Phone
Disclaimer of Liability: To permit campers to participate in the camp sessions at the rates offered and maintain the camp staff within the budget permitted by these rates, The Orchard Lake Schools and its agents and employees thereof shall not be liable for any damages arising from personal injuries sustained by the camper during the camp or at the facilities for any derivative claim, the camper and his/her parents assume full responsibility for damages or injuries which may occur to the camper during the camp session and do hereby fully and forever release and discharge Orchard Lake Schools and it’s summer camps, staff, employees and agents, from all claims, demands, damages, rights of action or causes of action, present or future, whether the same be known, anticipated or unanticipated, resulting from or arising out of the campers participation in the camp sessions and in the use of the facilities, equipment and grounds. I hereby certify that my child is healthy and free from and condition or injury so that he/she may participate in this program.
Signature of Parent or Legal Guardian:
Signature (Print) of Parent of Legal Guardian:
Date of Signature
SPECIAL DISCOUNT REGISTRATION - Orchard Lake is offering a special discounts for the 2012 camps. Campers can find special discount codes in The Monthly Shopper. Please enter the four digit code from your brochure , advertisement or online registration to receive your special discount.
MULTIPLE CAMP DISCOUNT
Once you have registered for two or more camps, a special promotional code will appear and you will receive your discount!!
Sign Up for two weeks of camp and you will receive....$20 off total fees
Sign Up for three weeks of camp and you will receive...$40 off total fees
Sign Up for four weeks of camp and you will receive....$60 off total fees
SPECIAL HOCKEY DISCOUNT: BRING A FRIEND!!! Receive a $25 Discount for two (2) Hockey Registrations.
**To receive your discounts, please register online or mail registrations to:
Orchard Lake Schools
Attn: Summer Camp Discount
3535 Indian Trail
Orchard Lake, MI 48324
For any additional Questions please call 248-706-4200!
POLICIES:
1) Summer Camps at Orchard Lake adhere to strict payment and behavior policies. Please review all the materials.
MAKE CHECKS PAYABLE TO:
ORCHARD LAKE SCHOOLS
3535 INDIAN TRAIL
ORCHARD LAKE, MI 48324
2) Check Camp availability by calling: (248) 706-4200.
3) Parents arriving later than 15 minutes after the published time of the camp will be charged $5 per 15 minutes in late fees.
4) The Orchard Lake Schools will impose a $35 returned check fee for any returned checks or invalid credit card payments.
5) A $100 non-refundable administrative fee will be charged if a camper cancels.