CONTE’S PALM-AIRE GOLF ACADEMY
2015 JUNIOR SUMMER GOLF CAMP APPLICATION
Camper Personal Data
NAME
(LAST)
(FIRST)
(Name by which camper would like to be addressed (i.e. Mike, Michael): _________________________
ADDRESS
CITY/STATE/ZIP
PHONE (
SEX [
COUNTRY
)
]M [
E-MAIL ADDRESS
]F
DATE OF BIRTH (MM/DD/YY)
NAME OF SCHOOL
AGE AT CAMP
GRADE AS OF SEPTEMBER 2013
WHERE/HOW DID YOU HEAR ABOUT US?
Parent/Guardian Information
FATHER’S NAME
MOTHER’S NAME
ADDRESS
ADDRESS
CITY/STATE/ZIP
CITY/STATE/ZIP
PHONE HOME/WORK
PHONE HOME/WORK
PHONE CELL/PAGER
PHONE CELL/PAGER
I would like to register my child for the following week(s): Full Day [ ] Half Day [ ]
[
[
[
] Week 1 June 8 – 12, 2015
] Week 2 June 15 – 19, 2015
] Week 3 June 29 – July 3, 2015
[ ] Week 4 July 6 – 10, 2015
[ ] Week 5 July 13 – 17, 2015
[ ] Week 6 July 20 –24, 2015
Pee Wee [ ]
[ ] Week 7 July 27 – 31, 2015
[ ] Week 8 Aug 3 –Aug 7 2015
Camp space is limited and applications with payment must be completed in full and received prior to camp date.
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CONTE’S PALM-AIRE GOLF ACADEMY
2015 JUNIOR SUMMER GOLF CAMP APPLICATION
Payment of Fees
Junior Campers -ages 8 – 16
Standard camp tuition: $295 per week / per child Monday-Friday 9a.m. to 3 p.m.
Early Registration (Before May 15, 2015): $265 per week / per child if pre-paid before May 15, 2015
Half Day Camp tuition: $165 per week/per child Monday-Friday 9a.m. to 12p.m.
Early Registration (Before May 15, 2015): $150 per week / per child if pre-paid before May 15, 2015
These camps include daily golf instruction, range balls, daily golf fees (weather permitting), snacks and a Pizza
lunch on Fridays.(Jr. Campers should bring packed lunch Mondays thru Thursdays.)
Pee Wee Campers (ages 4 – 7 )
Standard camp tuition: $125per week / per child. Tues - Wed -Thurs 9a.m. to 12p.m.
Early Registration (Before May 15, 2015): $100 per week/ per child if pre-paid before May 15, 2015
This camp includes daily golf instruction, range balls, daily golf fees (weather permitting) and snacks.
Discounts: A 10% discount per child off camp fees may apply provided said child (children) meets one of the
following discount criteria:




Two (2) or more children in the same family attending camp, or
Pre-payment / registration for two (2) or more weeks of camp
Children / Grandchildren of current Palm-Aire Country Club Members, or
Current students and participating school partners.
*Maximum discount is 10%; discounts are not cumulative and cannot be applied to Continued Care. Discounts are applied
to each prepaid child attending a full week of camp only. Discounts cannot be retroactively refunded. Cannot be combined
with early registration discount.
Registration: All camp payments and completed applications for the following week are due at least 7 days in
advance. Acceptable forms of payment include Visa, MasterCard, Discover, cash and local check (There is a $30
charge for any returned checks that fail to clear).
Refund/cancellation policy: Notification of withdrawal must be made in writing to the camp. There will be a full
refund of all moneys paid if notice of cancellation is given 14 days or more prior to the first day of camp. There will
be a 50% refund of all moneys paid if notice of cancellation is given 7 to 13 days prior to the first day of camp. There
will be NO refund if notice of cancellation is given less than 7 days prior to the first day of camp.
There will be no refund for a student who is asked to leave for the use of drugs or alcohol, non-notification of a
serious medical condition, or whose conduct is detrimental to the camp, (these decisions are the sole discretion of
Camp Directors). No refund will be made for late arrival or early departure or withdrawal due to illness or family
vacation.
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CONTE’S PALM-AIRE GOLF ACADEMY
2015 JUNIOR SUMMER GOLF CAMP APPLICATION
Important Contact Information:
Camp Directors:
Stephen Conte: 954-254-3010 cell
Michele Conte: 954-471-7272 cell
Conte’s Palm-Aire Golf Academy Office: (954) 971-7867
Mailing Address: 3701 Oaks Clubhouse Drive, Pompano Bach, FL 33069
Camp Hours of Operation
Pee Wee Golfers (ages 4 – 7): 9:00 a.m. to 12 noon Tues,, Wed, Thurs
Junior Golfers (ages 8 to 16): 9:00 a.m. to 3:00 p.m. Monday- Friday
Camp Headquarters is located in The Oaks Clubhouse, 3701 Oaks Clubhouse Dr Pompano Beach, Fl 33069. This
area will serve as the primary area of many camp activities, including drop-off and pick up.
Camp Starts at 9:00 a.m. for all campers. Camp doors open daily at 8:30 a.m. There is no adult supervision
before this time so for the safety of your child, do not “drop off” or leave your child without registering them for
the day with an adult camp representative.
Camp Ends at 12 noon for Pee Wee Golfers (ages 4 to 7) and at 3:00 p.m. for Junior Golfers (ages 8 to 16).
Late Fees: Camp reserves the right to charge a $20 late fee per occurrence for any child who is picked up by an
authorized parent or guardian more than 30 minutes after the end of camp. (Camp ends for Pee Wee Golfers at 12
noon so any pick-up after 12:30 p.m. would be considered late. Camp ends for Junior Golfers at 3:00 p.m. so any
pick-up after 3:30 p.m. would be considered late.)
Daily Sign-in / Sign-Out: All campers are required to be signed in and out by an authorized parent or guardian
every day. Proper identification and written permission from a parent or guardian is required before any student is
permitted off property. Following is a list of authorized person(s) other than parent/guardian to pick up my child
(children) from camp:
*NAME
RELATIONSHIP
PHONE
CELL/BPR.
*Photo identification is required from all person(s) authorized to pick-up campers (including parent or guardian).
Visiting\Pick-Up: Parents and guests are welcome to visit at any time during camp hours. For drop-off & pick-up,
parents or guardians MUST sign in and out each day.
Proxy Dismissal Consent: Parents or guardians of campers who walk or ride bikes to camp must complete a
Proxy Dismissal Consent Form (See page 7) in order to sign-in and out of camp without an adult signature during
eligible drop off / pick-up times.
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CONTE’S PALM-AIRE GOLF ACADEMY
2015 JUNIOR SUMMER GOLF CAMP APPLICATION
Items to Bring: Campers should bring the following items to camp on a daily basis: sunscreen, hat/cap, sneakers,
golf shoes (optional), golf clubs and snacks (other than those provided by Camp).
Lunch: Junior Campers (ages 8 to 16) should bring a packed lunch to camp every day, preferably in an
insulated cooler or bag. On Friday “PIZZA DAYS”, pizza will be provided to all Junior Campers at no
additional charge. [Note: Pizza lunch is not included in Pee Wee Campers (ages 4-7).]
Camp Rules: Students are not permitted to smoke while in the program. Alcoholic beverages and illegal substances
of any type are forbidden. Gambling is not permitted at camp. Profane language is prohibited. We will not be
responsible for any electronics or cell phones that may be lost or misplaced.
Parents will be notified of any infraction of camp rules. The camp reserves the right to dismiss and send home
participants whose conduct is deemed detrimental to the camp. Camp policy is not to refund the tuition of any camper
sent home under these circumstances.
Photos: The Camp retains the right to use photographs of this camper for advertising purposes.
Parent/Guardian Agreement:
I have read the application and give my permission for my son/daughter to participate in the Conte’s Palm-Aire Golf
Academy Junior Summer Golf Camp. I agree that my son/daughter will abide by the rules and regulations of the
program, and I realize that any breach of these rules may result in his/her immediate dismissal without refund of any
fees.
I authorize The Camp, or its authorized representatives, to take whatever action it may consider to be warranted under
the circumstances regarding my child’s health and safety, and I fully release The Camp and its authorized
representatives from any liability for such circumstances or actions as may be taken in connection therewith.
I authorize The Camp, or its authorized representatives, at its discretion in an emergency situation, to place my child,
at my own expense and without further consent, in a hospital for medical services and treatment, or if no hospital is
readily available, to place my child in the hands of a licensed doctor for treatment.
PARENT/GUARDIAN SIGNATURE
DATE
___________
Participant’s Agreement: I agree to abide by the rules of the Summer Camp Program. I understand that the camp
has the right to dismiss me and return me to my parent/guardian, without refund, if I violate camp rules.
SIGNATURE OF CAMPER
DATE___________
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CONTE’S PALM-AIRE GOLF ACADEMY
2015 JUNIOR SUMMER GOLF CAMP APPLICATION
Conduct
I understand that by enrolling in the Conte’s Palm-Aire Golf Academy 2015 Junior Summer Golf Camp, I
am expected to obey the rules and regulations of Palm-Aire Country Club and to conduct myself as a
responsible golfer. If I do not conduct myself responsibly, my golfing privileges will be revoked and my
lessons discontinued without refund.
Liability Waiver
I understand that the sport of golf involves certain potential risks. In consideration of my acceptance into
this summer camp program, I hereby release any and all rights and claims for damage against the Conte’s
Palm-Aire Golf Academy, Palm Aire Country Club, their agents, and any instructors or volunteers. Also,
the Conte’s Palm-Aire Golf Academy has my permission to render any necessary first aid treatment to my
child while in attendance at the camp program and activities.
______________________________
Name of Parent / Guardian
______________________________
Name of Camper
______________________________
Signature of Parent / Guardian
______________________________
Signature of Camper
___________
Date
Note: When weather is questionable, please call the Conte’s Palm-Aire Golf Academy (954) 971-7867
before transporting children to course. We will have some indoor options and activities.
There will be no make-up dates unless there is a rain out.
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CONTE’S PALM-AIRE GOLF ACADEMY
2015 JUNIOR SUMMER GOLF CAMP APPLICATION
CAMPER HEALTH HISTORY FORM
Please complete the Health Information / Emergency Contact below, which must be signed by a parent or guardian.
This form is to be returned to our office one week prior to the start of the camper’s first session.
The Conte’s Palm-Aire Golf Academy Junior Summer Golf Camp requires a complete medical examination of each
camper prior to registration. Please identify a friend or relative as an emergency contact in the event you cannot be
reached and your child requires medical attention.
NAME
BIRTH DATE
SEX
AGE
PARENT OR GUARDIAN
HOME ADDRESS
PHONE
BUSINESS ADDRESS
PHONE
SECOND PARENT OR GUARDIAN/EMERGENCY CONTACT
HOME ADDRESS
PHONE
BUSINESS ADDRESS
PHONE
IF NOT AVAILABLE IN AN EMERGENCY, NOTIFY:
NAME
RELATIONSHIP:
ADDRESS
PHONE
PRIMARY PHYSICIAN
PHONE:
HEALTH INFORMATION:
Please list any known allergies and any other special medical issues that the camp should be aware of . . .
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Emergency Authorization: I hereby give permission to the medical personnel selected by the camp director to order X-rays, routine tests
and treatment for my child, and in the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the
camp director to hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for my child as named
above. This form may be photocopied for use out of camp.
SIGNATURE OF PARENT OR GUARDIAN
DATE
WITNESS
DATE
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