Child's Information Date of Birth * MM 1 2 3 4 5 6 7 8 9 10 11 12 DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Choose your Full time Camp Weeks
Camp opens at 7am and closes at 6pm. Your child can arrive and depart any time during these hours. Lunch and Snacks are included.
Week 1 Drop in Dates Monday, December 19, 2022 Tuesday, December 20, 2022 Wedesday, December 21, 2022 Thursday, December 22, 2022 Friday, December 23, 2022 Week 2 Drop In Dates Monday, December 26, 2022 Tuesday, December 27, 2022 Wedesday, December 28, 2022 Thursday, December 29, 2022 Friday, December 30, 2022 Parent/Guardian Information Email * Emergency Contact Medical Concerns or Allergies *
If your child has special needs, allergies or takes medication during the day. If your child has none, please acknowledge by writing NONE in the box. This box must have something written to submit the form.
Medication Policy *
Administration of medication will be performed by the staff. Parents must complete a medication form for medicines to be given on a regular basis. Medications necessary for short term basis only must be accompanied with a signed written directive indicating dosage and time for administration.
Should a camper become ill, the supervisor will attempt to make phone contact with persons listed on the camper’s Emergency Contact Sheet. For emergency situations requiring immediate medical attention, Jones County Rescue will be contacted. Parents should indicate their hospital of choice at the time of registration in the event of necessary emergency transportation.
Please sign and date below indicating that you agree to these terms.
Discipline Policies at Skate Camp *
Children will be disciplined according to the severity of the misbehavior. Actions will include: verbal warnings, loss of privileges (5-10 minutes), parent conferences, suspension or removal from the program. The discipline measure taken will be at the discretion of the staff member involved, and the Program Director. The Director may immediately suspend a child at anytime should the child’s behavior become extremely harmful to the staff, children or him/herself.
Behaviors that may result in immediate suspension or removal from the program include:
-Any type of fighting
-Intimidating, harassing or threatening others
-The use of profane language, gestures or behaviors
-Leaving the camp area without supervision of a staff member
-Defacing or damaging property of Gray-8-Skate, other campers or staff .
It is understood that chronic misbehavior could result in the termination of services from the camp.
Parental/Guardian Signing in and out of Skate Camp *
Campers must be signed in and out daily by a parent or authorized person. Campers may be picked up or dropped off anytime during our operating hours. Campers will only be released to parent/guardian and/or people specifically authorized on student information sheet. Children may NOT sign themselves in or out. For the safety of your child, individuals may be required to show proof of ID at anytime.
If special consideration/concerns regarding pick up exist, the parents should notify the supervisor in advance of the situation and should complete a “Special Pick Up” form. Custody concerns should be discussed with administration and proper legal papers provided.
All children must be picked up by 6:00 P.M. A late fee of $1.00 for every minute late will automatically be charged to the parent’s/guardian’s tuition account. A fee of $10.00 plus $1.00 per minute is added after first late pick up.
Waiver of Liability *
The Participant and/ or their parent(s) or guardian understands, acknowledges, and agrees that roller skating is an inherently dangerous and physically demanding activity. Participating skater assumes full responsibility for any risk of injury, property damage, or death while participating in activities at this establishment.
Participant and/ or their parent(s) or guardian hereby waive any andall claims including, but not limited to: bodily injury including death and property damage they may have against GRAY-8-SKATE (its parents, subsidiaries, partners and affiliates) and all sponsors of the roller rink and their
subsidiaries, affiliates, partners, officers, directors, employees, agents, and volunteers from arising out of Participant’s use of the Roller Rink and all surrounding areas. Participants and/ or their parent(s) or their guardians hereby release and hold harmless GRAY-8-SKATE (its parents, subsidiaries, partners and affiliates) and all sponsors of the Roller Rink and their subsidiaries, affiliates, partners, officers, directors, employees, agents, and volunteers from any and all liability for any loss, damage, or expense that the Participants or their respective heirs, assigns and legal representatives may suffer as a result of Participant’s use of the Roller Skating Rink, from any cause whatsoever, including but not limited to, negligence or breach of contract on the part of GRAY-8-SKATE (its parents, subsidiaries, partners, and affiliates, and all sponsors of the Roller Rink, in the operation, supervision, design, maintenance, or condition of the synthetic surface, or of the Roller Rink and all surrounding areas.
Participant permits GRAY-8-SKATE , its parents, subsidiaries, partners, and affiliates to use any photographs, videotapes, recording or any other records taken while on the synthetic Roller Rink for publicity, advertising, or any other legitimate purpose, without compensation to the Participant.
BY SIGNING THIS RELEASE OF LIABILITY AND WAIVER OF ALL CLAIMS, I UNDERSTAND THAT I AM RELEASING GRAY-8-SKATE ROLLER RINK FROM ANY CLAIMS FOR NEGLIGENCE AND DAMAGES CAUSED BY GRAY-8-SKATE NEGLIGENCE AND AGREEING TO THE OTHER TERMS IN THIS DOCUMENT. BY SIGNING I ALSO AGREE TO PAY FOR ANY DAMAGES CAUSED TO EQUIPMENT CAUSED BY ABUSE OR MISUSE IN A CASH AMOUNT OF NO LESS THAN $10.00 (THIS INCLUDES SKATING ON SURFACES OF THE ROLLER RINK). I HAVE CAREFULLY READ THIS WAIVER, RELEASE OF LIABILITY AND
ASSUMPTION OF RISK AGREEMENT IN ITS ENTIRETY AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A WAIVER, RELEASE OF LIABILITY, ASSUMPTION OF RISK AGREEMENT AND A LEGAL CONTRACT BETWEEN ME AND GRAY-8-SKATE AND THAT IT AFFECTS MY LEGAL RIGHTS.
I AM SIGNING THIS DOCUMENT OF MY OWN FREE WILL. A PHYSICAL AND ELECTRONIC COPY OF THIS DOCUMENT IS AUTHENTIC AND IS AS EFFECTIVE AS THE ORIGINAL AND DOES NOT EXPIRE.
Participants must be at least 18 year-old or have parent or guardian sign below on their behalf Notice of Exemption *
I acknowledge that I have been informed that this program is not a licensed child care facility. I also understand this program is not required to be licensed by the Georgia Department of Early Care and Learning. I understand this program is exempt from state licensure requirements.