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Online Application for Davie Camp

APPLICATION FOR ACCEPTANCE SUMMER 2012

This is the online application form for Davie Nadadores Swim Camp, Jun 17th to Aug 25th 2012. After filling out, click on SUBMIT button. The system will generate a formatted webpage which must be printed and signed by parent or guardian, and submitted to Davie Nadadores office by mail (4431 SW 64th Ave, suite #112, Davie/Florida, ZIP CODE 33314), e-mail (daviecamp@davienadadores.com) or fax (+1 954 587-4554).

THE CAMP

Select the type of swimming camp you'd like to participate :

Competitive Overnight Camp
Competitive Day Camp

CAMPER INFORMATION

Fill the following fields with your personal information

Male Female

Age in 2012:

years

School grade:

Date of birth (mm-dd-yyyy):

Size of shirt:

Camper's full name:

Full residence address:

Residence city:

Residence state:

Residence ZIP code:

Residence country:

Phones (with area code):

Camper's e-mail:

Favorite events and best times:

For example, 50 freestyle 27.50, 100 backstroke 1:00.40, etc

PARENTS INFORMATION

Fill the following fields with your parents information

Father's full name:

Address (if different from camper):

Day or cell phone (with area code):

Home phone number (with area code):

Father's e-mail:

Mother's full name:

Address (if different from camper):

Day or cell phone (with area code):

Home phone number (with area code):

Mothers's e-mail:

Parent's marital status:

If divorced, who has the custody of child?

Not applicable Mother Father

Tuition to be paid by:

Not applicable Mother Father

Send camper account refunds to:

Not applicable Mother Father

CAMPER EXPERIENCE

Please indicate name of camp attended (if any) in the following years.

Camp experience in 2011:

Camp experience in 2010:

Camp experience in 2009:

Camp experience in 2008:

How did you hear about Davie Nadadores?

SESSIONS

Campers may attend for any number of weeks during the 10 weeks of camp. We recommend at least a two-weeks minimun stay. If campers wish to extend their contracted time while in camp, the Directors will fill request on space available. Check the desired weeks according to the camp type chosed:

Options for overnight camp:

Week 1: Jun 17th to Jun 23rd
Week 2: Jun 24th to Jun 30th
Week 3: Jul 1st to Jul 7th
Week 4: Jul 8th to Jul 14th
Week 5: Jul 15ht to Jul 21st
Week 6: Jul 22nd to Jul 28th
Week 7: Jul 29th to Aug 4th
Week 8: Aug 5th to Aug 11th
Week 9: Aug 12th to Aug 18t
Week 10: Aug 19th to Aug 25th

Options for day camp:

Week 1: Jun 18th to Jun 22nd
Week 2: Jun 25th to Jul 29th
Week 3: Jul 2nd to Jul 6th
Week 4: Jul 9th to Jul 13th
Week 5: Jul 16th to Jul 20th
Week 6: Jul 23rd to Jul 27th
Week 7: Jul 30th to Aug 3rd
Week 8: Aug 6th to Aug 10th
Week 9: Aug 13th to Aug 17th
Week 10: Aug 20th to Aug 24th

DUES (this box is only for information: all fees and dues will be displayed when you finished this online form)
# of Weeks	Overnight Camp (US$)	Day Camp (US$)	Camper Escrow Overnight (US$)	Camper Escrow Day Camp (US$)
1 week	775	485	200	200
2 weeks	1525	970	350	250
3 weeks	2290	1455	450	300
4 weeks	2995	1940	550	350
5 weeks	3750	2425	600	400
6 weeks	4500	2910	650	450
7 weeks	5245	3395	700	500
8 weeks	5970	3880	750	500
9 weeks	6720	4365	800	550
10 weeks	7475	4850	800	550

Extra nights:

(US$ 125 each night)

PRIVATE COACHING

Standard private coaching (including four 30-minutes sessions):

Number of lessons (Standard private coaching):

(US$ 200 each lesson)

Video coaching (including a personalized DVD and four 30-minutes sessions):

Number of lessons (Video coaching):

(US$ 250 each lesson)

REGISTRATION FEES

All camp payments must be paid prior to camp arrival

Registered until May 31st 2012:

US$ 100

Registered after May 31st 2012:

US$ 150

ENGLISH CLASSES

Davie Nadadores Swim Camp offers a new opportunity to your child. Combining our swimming program with an English classes at Talk International Language Course. Campers will attend the regular morning workout and will have an english classes participating at the regular evening schedule.

School Registration Fee

US$ 150

English Course per week (5 days a week)

US$ 280

Number of lessons:

TRAVEL INFORMATION

TRAVEL BY CAR

Arrival by Car?

Yes

Arrival by Car - Date and Time:

Departure by Car - Date and Time:

TRAVEL BY PLANE

Arrival by Plane?

Yes

Arrival by Plane - Date (mm-dd-yyyy):

Arrival by Plane - Time (at destination, please include AM or PM):

Arrival Airline :

Arrival Flight # :

Arrival Airport:

FLT MIA

Will you be clearing US Customs in FLT or MIA?

Yes

Departure by Plane - Date (mm-dd-yyyy):

Departure by Plane - Time (at origin, please include AM or PM):

Departure Airline :

Departure Flight # :

Departure Airport:

FLT (US$ 25 fee) MIA (US$ 75 fee)

Will you be clearing US Customs in FLT or MIA?

Yes

Will camper be signed over to the airline?

Not applicable Yes No (only if 12 years-old and under)

HEALTH INSURANCE INFORMATION

EVERY CAMPER MUST HAVE THIS FORM ON FILE

Private insurance information must be provided if applicable. If a camper does not have private health insurance, please be advised that, should a camper require medical attention, you are responsible for paying any cost not covered by the insurance.

Camper Social Security Number:

Insurance Company Name:

Efective Date (mm-dd-yyyy):

Full Address of Insurance Company:

Phone Number of Insurance Company (with area code):

Group Number:

Policy's Holder Name:

Full Policy's Holder Address (with zip code and country):

Insurance Policy Number:

Relationship to Camper:

Name of Primary Care:

Phone Number of Primary Care (with area code):

MEDICAL INFORMATION

Please complete this form in its entirety. This information will be helpful in the unlikely event of an accident or sudden illness.

In the space provided below, list any pertinent health or medical information and instructions or special problems (allergies, tetanus booster dates, drug allergies, asthma, prescriptions, etc)

Aside from yourselves (the parents of the camper), please indicate (in order) those individuals that you would like the coaches to contact should there be an emergency involving your child:

Camper's Doctor

Camper's Doctor Phone Number (with area code)

Camper's Dentist

Camper's Dentist Phone Number (with area code)

For emergency 1 if parents or guardian are unavailable

Phone Number (with area code)

For emergency 2 if parents or guardian are unavailable

Phone Number (with area code)