2016 GAC SUMMER TENNIS CAMP REGISTRATION
FAMILY INFORMATION:
PARENT / GUARDIAN 1
PARENT / GUARDIAN 2
First Name: _________________________
First Name: __________________________
Last Name: _________________________
Last Name: __________________________
Home Phone: _______________________
Home Phone: ________________________
Cell Phone: _________________________
Cell Phone: __________________________
Email: _____________________________
Email: ______________________________
GAC Member ID (If applicable): ____________________
EMERGENCY CONTACT
EMERGENCY CONTACT IS THE SAME AS PARENT/GUARDIAN: YES
NO
(IF ‘NO’ COMPLETE CONTACT INFO. BELOW)
EMERGENCY CONTACT: First Name: ____________________Last Name: ___________________
EMERGENCY PHONE: __________________
RELATIONSHIP TO CAMPER: __________________
PICK UP AT THE END OF CAMP DAY: PARENT ________________ Other ___________________
If Other; Phone:___________________ Name and Relationship to Camper__________________
CAMPER(S) INFORMATION
CAMPER 1
CAMPER 2
FIRST NAME:
FIRST NAME:
______________________________
LAST NAME:
______________________________
______________________________
LAST NAME:
______________________________
DATE OF BIRTH :(DD/MM/YY)
AGE: ____
__________
GENDER: □ M
□ F
PLAYING EXPERIENCE:
□
BEGINNER
□ INTER/ADVANCED
DATE OF BIRTH :(DD/MM/YY)
AGE: ____
GENDER:
__________
□M
□ F
PLAYING EXPERIENCE:
□
BEGINNER
□ INTER/ADVANCED
ALLERGIES / ILLNESSES:
ALLERGIES / ILLNESSES:
DIETARY RESTRICTIONS:
DIETARY RESTRICTIONS:
____________________________________
HEALTH CARD NUMBER AND VERSION CODE:
____________________________________
SPECIAL INSTRUCTIONS FOR CARE OF MY CHILD:
______________________________________
______________________________________
______________________________________
____________________________________
HEALTH CARD NUMBER AND VERSION CODE:
______________________________________
SPECIAL INSTRUCTIONS FOR CARE OF MY CHILD:
________________________________________
________________________________________
________________________________________
________________________________
2016 GAC SUMMER TENNIS CAMP REGISTRATION
CONSENT & RELEASE
I give permission for my child/children to participate in the Glendon Athletic Club
programs/camps and agree that York University, its employees, officers, Board of Governors
and agents will not be held responsible for any accident or loss however caused and agree to
release them from all claims and damages which may arise as a result of such accident or loss.
In signing this consent and release agreement, I hereby acknowledge that I have read and
understood the conditions and certify that my child is in good physical health and that there is no
medical reason why he/she should not attend.
Name of Camper(s): First Name:____________________ Last Name: ___________________
First Name: ____________________ Last Name: ____________________
Name of Parent/Guardian:
First Name: ____________________ Last Name: ____________________
Signature of Parent/Guardian: _______________________Date: ______________________
PHOTO PERMISSION FORM
I give permission for the use of any photos of my child/children taken while participating in any
Glendon Athletic Club program/camp to appear in a future brochure or other future
program/camp advertising.
Name of Camper(s): First Name:____________________ Last Name: ____________________
First Name: ____________________ Last Name: _____________________
Name of Parent/Guardian:
First Name: _________________ Last Name: _______________________
Signature of Parent/Guardian: ________________ Date: ____________________________
2016 GAC SUMMER TENNIS CAMP REGISTRATION
CAMPER’S NAME (S): _____________________________________________________________________
TENNIS CAMP DETAILS:
After School Spring Starter Camp
Starter Camp: Wednesdays (May 11 – June 15)
Camp Dates (Please select):
Extended Care:
4
Yes
Beginner: 6 – 7pm
Annual
Member rate
(per week)
Inter/Advanced: 7 – 8pm
5 DAY CAMPS:
J UNE 20 – 24
J ULY 25 – 29
J ULY 4 – 8
AUG 8 – 12
J ULY 11 – 15
AUG 15 – 19
J ULY 18 – 22
AUG 22 - 26
DAY CAMPS:
J UNE 27 – 30
AUG 2 – 5
No
Visit:
www.glendon.yorku.ca/gac
for more camp information
Junior Tennis Camp
Monthly &
10% Member
Non-Member Rate Family Discount
(for each additional
(per week)
family member)
Starter Camp
Junior Tennis Camp (4 days)
Junior Tennis Camp (5 days)
Extended Care (4 days)
Extended Care (5 days)
$ 100.00
$ 260.00
$ 325.00
$ 40.00
$ 50.00
$ 120.00
$ 320.00
$ 400.00
$ 40.00
$ 50.00
$ 90.00
$ 234.00
$ 292.50
n/a
n/a
Child 1 Camp Fees
Child 2 Camp Fees
Extended Care Fees
Subtotal
Total Fees
METHOD OF PAYMENT
□
VISA
□
10% Non-Member
Family Discount
(for each additional
family member)
$ 108.00
$ 288.00
$ 360.00
n/a
n/a
$
$
$
$
$
MASTERCARD
Card Number:
__________________________________________________________
Expiry Date:
__________________
Security Code: _______________________
Card Holder Name: ________________________ Signature of Cardholder: __________________________
I hereby authorize the Glendon Athletic Club (York University) to charge my credit card in the amount of
$____________.
Full payment is due upon registration either by fax, mail, over the phone or in person.
E-MAIL/FAX REGISTRATIONS TO:
Glendon Athletic Club, 2275 Bayview Ave, Toronto, Ontario M4N 3M6
Attention: Aaron Rodrigues, Racquets Professional Email: racquets@glendon.yorku.ca
Fax: 416-487-6789
2016 GAC SUMMER TENNIS CAMP REGISTRATION
Rules and Regulations
1. Discount
 A 10% discount will be applied for additional family members at the time of
registration for any week in our tennis camps.
2. Weather Condition

In the event of inclement weather, the camps will NOT be cancelled. Instead,
campers will come indoors for organized activities.
3. Cancellation

To ensure fair access to camp spaces, cancellations and refunds are not permitted.
4. York Student

Children of York Student members are eligible for the Annual Member rate.
5. Deadlines
 Registrations must be received by 12:00pm noon the Thursday before camp
starts. No registrations will be accepted after this day/time for the following
week.