Week
Mon
Tues
Wed
Thurs
Fri
1
6/20
6/21
6/22
6/23
6/24
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6/27
6/28
6/29
6/30
7/1
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7/4
7/5
7/6
7/7
7/8
4 of July
No fieldtrip
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7/11
7/12
7/13
7/14
7/15
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7/18
7/19
7/20
7/21
7/22
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7/25
7/26
7/27
7/28
7/29
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8/1
8/2
8/3
8/4
8/5
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8/8
8/9
8/10
8/11
8/12
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8/15
8/16
8/17
8/18
8/19
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8/22
8/23
8/24
8/25
8/26
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8/29
8/30
8/31
9/1
9/2
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2
3
th
4
5
6
7
8
9
10
11
*yellow Field Trip Day * Blue Presenter’s Day
CAMP REGISTRATION FORM
*Please complete the separate information form, prior to your child’s drop off*
Participant’s Name: ____________________________
DOB: __/___/____ Age: ____
Parent/ Guardian Name: _______________________ Phone: (____) _____-_____
Address: _____________________ City: ________________ State: ____ Zip: ____
E-Mail: ___________________________________________
Are you a Member? YES: ____ NO: ____
If YES, Member Number: ______
There is an inherent risk of injury in the use of or presence in Great Lakes Athletic Club, the use of its equipment
and services and participation in its programs, whether such participation occurs at the facility or in supervised or
unsupervised activities sponsored or endorsed by GLAC outside the facility. I understand and fully accept this risk
for myself or on behalf of my minor child and shall hold this club, its shareholders, directors, officers, employers,
representatives and agents harmless from any loss, claim, injury, damage or liability sustained or incurred by me or
my minor child resulting there from. In the event of an emergency I give my permission to Great Lakes Athletic
Club to secure all necessary and required medical treatment for the above named participant.
Parent’s Name:____________________________________ Date:____/____/20__
Payment
On Account:______ Cash:______ Check No.:__________
Credit Card:______ VISA
Master Card American Express Discover
Credit Card No.:________________
Expiration:___________ V-Code:___________
Amount Due: $_________
Signature:__________________________
Date:___________ Receipt No.:_________
Parent Signature:___________________________________________________________________
There will be a $5 administration fee applied to all camp
changes after your initial registration.
All payments are non-refundable.