Please print and mail to us at: PO Box 55-8605 Miami, FL 33255-8605
camp Ñ- Summer 2012 Registration Form
One application per camper – Application may be duplicated
Camper’s Last Name_______________________First Name__________________________ Age at camp____Birthday_______
Street Address____________________________________________City_________________State______Zip Code________
School______________________________________ Grade (Next Fall)___________ Previous camper? Yes____ No____
Mother's Name________________________ Father's Name_______________________ Email__________________________
Home Number__________________________ Work Number______________________ Mobile Number__________________
Tell us about your child’s special needs, allergies, and medications.
______________________________________________________________________________________________________
Campers are generally grouped by age. If you want your camper grouped with another specific camper, please
list the name and the reason for the request. We reserve the right to place campers where we think they will benefit most.
_____________________________________________________________________________________________________
Emergency Contact Person_____________________ Relationship_______________ Phone ____________________________
Pediatrician_______________________ Phone ____________ Medical Ins. _____________________Policy # _______________
Besides Parents, who else is authorized to pick up your child:
Name________________________________________ Phone ______________________________
As a swimmer my child is: Above Average____ Average____ Below Average____ Non-Swimmer____
Four year old campers do not go to the UM pool. As an alternative these campers have a splash day.
I give permission to my child to go to the UM pool: YES____ NO ____ Please initial here:___
T-Shirt Size:(T-Shirts run small) SMALL (6-8)____ MEDIUM (10-12)____ LARGE (14-16)___ X-LARGE(18-20)___
Mark with an X the appropriate selection: SESSIONS MAY NOT BE SPLIT
Session A-6/11-6/22 Tuition $360 __ Lunch $50__ AM Care $60__ PM Care $120 ___ Total $_________
Session B-6/25-7/6 Tuition $360 __ Lunch $50__ AM Care $60__ PM Care $120 ___ Total $_________
Session C- 7/9-7/20 Tuition $360 __ Lunch $50__ AM Care $60__ PM Care $120 ___ Total $_________
Session D-7/23-8/3 Tuition $360 __ Lunch $50__ AM Care $60__ PM Care $120 ___ Total $_________
1 Week –Indicate Wk:____Tuition $240 __ Lunch $25__ AM Care $30__ PM Care $60 ___ Total $_________
Early Registration Discount: Subtract amount indicated below from the total if application is postmarked by 3/15/2012_____________
1 week $5 - 1 Session $15 - 2 Sessions $30 - 3 Sessions $45 - 4 Sessions $60
Sibling Discount- Less $20.00 for each additional sibling:_________________
50% Deposit Due with Registration:__________________
Amount Due(May 15, 2012):________________________
______________________________________________________________________________________________________
Snack: Each camper will be provided with a snack and a drink daily. A snack and a drink will also be given to After Care
campers.
Camp Location: The camp is located at the University of Miami in the heart of Coral Gables. The camp indoor activities will
take place at the BSU building, 1200 Stanford Drive. Outdoor activities and games will take place in the fields of the UM Campus.
Conduct: Camp reserves the right to dismiss a camper if their behavior jeopardizes other campers’ safety and well-being.
Field Trips: Campers will be going on a field trip every Tuesday. Transportation will be provided by MDCPS licensed buses. If you
prefer, you may follow the bus in your own car with your child. Campers must wear their camp t-shirt on all field trips.
Necessary Clothing: We recommend a T-shirt, shorts, socks and tennis shoes to be worn. Do not wear open-toed shoes for safety
reasons. Please label your swimsuit, lunch box, and all personal items. Camp Ñ will make every reasonable effort to
protect property but will not be responsible for lost items.
Morning Care: Morning Care hours are 8:00-9:00 am. If you are not pre-registered for Morning Care, the daily rate is $10.00.
Pick-Up Time: All campers in Day Camp and After Care must be picked up on time. Day Camp pick-up 3:00 pm.
After-Care: We provide after care until 5:30 pm. If a camper is not picked up by 3:00 pm he/she will automatically be placed in after
care for $20.00 a day. Late charges will apply for campers that are not picked up on time in After-Care.
Arrival Time: Camp starts at 9:00 am. Camp doors will open at 8:50 unless you are registered for Morning Care.
Registration Information: All registration forms received without a 50% deposit will not be considered. Deposits are non-
refundable. An early registration discount of up to $60 will be given to applications postmarked by March 15, 2012. The
balance of all sessions is due by May 15, 2012. Space per session is limited. Registrations will be taken on a first-come, first–
serve basis. Mail registration forms along with payment to:
camp Ñ, Inc.
PO Box 55-8605
Miami, FL 33255-8605
(305)669-6776
I hereby release, and waive my right to make a claim against, Camp Ñ, Inc., The University of Miami, The Baptist Student
Union and their officers and agents for any liability or damage arising from claims related to the camp activities, including
claims
for any injury sustained by my child(ren) while participating in any camp program or event. I authorize Camp Ñ, Inc. to have
my child(ren) treated in the event of an accident or injury if none of the above contacts can be reached.
I certify that I have read this document and that I understand and agree to all of the foregoing information, terms,
and conditions.
Parent’s/Guardian’s Signature:__________________________________________________________________
Print Name:_________________________________________Date:_________________________
We love to use photos in our promotional material on the internet. If you prefer that we NOT use your child’s image,
please initial here:______
camp Ñ- Summer 2012 Registration Form
One application per camper – Application may be duplicated
Camper’s Last Name_______________________First Name__________________________ Age at camp____Birthday_______
Street Address____________________________________________City_________________State______Zip Code________
School______________________________________ Grade (Next Fall)___________ Previous camper? Yes____ No____
Mother's Name________________________ Father's Name_______________________ Email__________________________
Home Number__________________________ Work Number______________________ Mobile Number__________________
Tell us about your child’s special needs, allergies, and medications.
______________________________________________________________________________________________________
Campers are generally grouped by age. If you want your camper grouped with another specific camper, please
list the name and the reason for the request. We reserve the right to place campers where we think they will benefit most.
_____________________________________________________________________________________________________
Emergency Contact Person_____________________ Relationship_______________ Phone ____________________________
Pediatrician_______________________ Phone ____________ Medical Ins. _____________________Policy # _______________
Besides Parents, who else is authorized to pick up your child:
Name________________________________________ Phone ______________________________
As a swimmer my child is: Above Average____ Average____ Below Average____ Non-Swimmer____
Four year old campers do not go to the UM pool. As an alternative these campers have a splash day.
I give permission to my child to go to the UM pool: YES____ NO ____ Please initial here:___
T-Shirt Size:(T-Shirts run small) SMALL (6-8)____ MEDIUM (10-12)____ LARGE (14-16)___ X-LARGE(18-20)___
Mark with an X the appropriate selection: SESSIONS MAY NOT BE SPLIT
Session A-6/11-6/22 Tuition $360 __ Lunch $50__ AM Care $60__ PM Care $120 ___ Total $_________
Session B-6/25-7/6 Tuition $360 __ Lunch $50__ AM Care $60__ PM Care $120 ___ Total $_________
Session C- 7/9-7/20 Tuition $360 __ Lunch $50__ AM Care $60__ PM Care $120 ___ Total $_________
Session D-7/23-8/3 Tuition $360 __ Lunch $50__ AM Care $60__ PM Care $120 ___ Total $_________
1 Week –Indicate Wk:____Tuition $240 __ Lunch $25__ AM Care $30__ PM Care $60 ___ Total $_________
Early Registration Discount: Subtract amount indicated below from the total if application is postmarked by 3/15/2012_____________
1 week $5 - 1 Session $15 - 2 Sessions $30 - 3 Sessions $45 - 4 Sessions $60
Sibling Discount- Less $20.00 for each additional sibling:_________________
50% Deposit Due with Registration:__________________
Amount Due(May 15, 2012):________________________
______________________________________________________________________________________________________
Snack: Each camper will be provided with a snack and a drink daily. A snack and a drink will also be given to After Care
campers.
Camp Location: The camp is located at the University of Miami in the heart of Coral Gables. The camp indoor activities will
take place at the BSU building, 1200 Stanford Drive. Outdoor activities and games will take place in the fields of the UM Campus.
Conduct: Camp reserves the right to dismiss a camper if their behavior jeopardizes other campers’ safety and well-being.
Field Trips: Campers will be going on a field trip every Tuesday. Transportation will be provided by MDCPS licensed buses. If you
prefer, you may follow the bus in your own car with your child. Campers must wear their camp t-shirt on all field trips.
Necessary Clothing: We recommend a T-shirt, shorts, socks and tennis shoes to be worn. Do not wear open-toed shoes for safety
reasons. Please label your swimsuit, lunch box, and all personal items. Camp Ñ will make every reasonable effort to
protect property but will not be responsible for lost items.
Morning Care: Morning Care hours are 8:00-9:00 am. If you are not pre-registered for Morning Care, the daily rate is $10.00.
Pick-Up Time: All campers in Day Camp and After Care must be picked up on time. Day Camp pick-up 3:00 pm.
After-Care: We provide after care until 5:30 pm. If a camper is not picked up by 3:00 pm he/she will automatically be placed in after
care for $20.00 a day. Late charges will apply for campers that are not picked up on time in After-Care.
Arrival Time: Camp starts at 9:00 am. Camp doors will open at 8:50 unless you are registered for Morning Care.
Registration Information: All registration forms received without a 50% deposit will not be considered. Deposits are non-
refundable. An early registration discount of up to $60 will be given to applications postmarked by March 15, 2012. The
balance of all sessions is due by May 15, 2012. Space per session is limited. Registrations will be taken on a first-come, first–
serve basis. Mail registration forms along with payment to:
camp Ñ, Inc.
PO Box 55-8605
Miami, FL 33255-8605
(305)669-6776
I hereby release, and waive my right to make a claim against, Camp Ñ, Inc., The University of Miami, The Baptist Student
Union and their officers and agents for any liability or damage arising from claims related to the camp activities, including
claims
for any injury sustained by my child(ren) while participating in any camp program or event. I authorize Camp Ñ, Inc. to have
my child(ren) treated in the event of an accident or injury if none of the above contacts can be reached.
I certify that I have read this document and that I understand and agree to all of the foregoing information, terms,
and conditions.
Parent’s/Guardian’s Signature:__________________________________________________________________
Print Name:_________________________________________Date:_________________________
We love to use photos in our promotional material on the internet. If you prefer that we NOT use your child’s image,
please initial here:______
