SPORTS & SWIM CAMP GSC Aquatics & Recreation - Kids 6-12 years old will enjoy fun games like basketball, Glenville State College

GSC Aquatics & Recreation

   SPORTS
   & SWIM
    CAMP
     Kids 6-12 years old will enjoy
        fun games like basketball,
          dodgeball, and wiffleball –
           followed by an afternoon
           of splashing in the pool!

PRICES
Five days - $180.00
Before Care - $25/5 days or $5 each morning
After Care - $25/5 days or $5 each evening

                               DETAILS
•   Monday through Friday 9:00 AM - 4:00 PM
•   Before Care 7:30-9:00 AM
•   After Care 4:00-6:00 PM
•   Drop-off and Pick-up at Health and PE Building
•   GSC Camp program keeps a daily log of temperature
    and symptom screening for campers and staff. Children’s
    temperatures will be taken upon arrival each day.

                                    PACK
All items must be labeled with child’s name

•   Bathing suit
•   Towel
•   Sunscreen
•   Camp bag (for personal belongings)
•   Healthy snack(s) and Lunch
•   Water bottle
•   Please, no nut products of any kind

             SIGN-IN & SIGN-OUT
Children must be accompanied into and out of the program space by
a parent or authorized person who is listed on the Registration Form.

People picking up and dropping off children must sign the
In/Out Roster and may be required to present a photo ID to
ensure that this safety regulation is enforced.

                                        Contact:
                    Kathy Gilbert, Director of Aquatics and Recreation
             Glenville State College | 200 High Street | Glenville, WV 26351
                      (304) 462-6441 | Kathy.Gilbert@glenville.edu

REGISTRATION FORM
Date of Application:___________________________

Child Name #1:_______________________________Age:___________

Allergies of Child #1:_________________________________________

Child Name #2:_______________________________Age:___________

Allergies of Child #2:_________________________________________

Parent/Guardian:___________________________________________

Address:__________________________________________________

City:_____________________________ , WV Zip Code:____________

Home Phone:____________________ Cell:______________________

E-mail:____________________________________________________

Preferred Camp Date:  June 28-July 2  July 26-30

Authorized people who can Sign-In or Sign-Out my child(ren):

               1)______________________________________________

               2)______________________________________________

  Please submit a $25 deposit per child, or payment in full, with registration form a
minimum of five days prior to camp. Credit card payments can be made to the Cashier at
Louis Bennett Hall. Cash or check made payable to Glenville State College can be giving to
   Fitness Center Staff Monday-Friday 12:00-6:00 PM or Saturday 11:00 AM-2:00 PM.
                    Registration forms and payment can be mailed to:
    Glenville State College, 200 High Street, Glenville, WV 26351 ATTN: Kathy Gilbert

Amount Submitted: ______________________ Date:_______________

                              **Continued on Back**

WAIVER
I acknowledge and accept the risks inherent in the use of the Glenville State College (GSC) services and recreation
facilities/swimming pool. The undersigned assumes the sole risk of injury, accident, death, loss, cost or damage
for his or her person, dependent or property which might arise from the use of Glenville State College services
and facilities. The undersigned further agrees that Glenville State College, it’s instructors, employees, servants,
and agents, shall not be liable to the undersigned for any claims, demands, injuries, damages, actions or causes
of action whatsoever to the undersigned’s person, dependent or property arising out of or in connection with the
use of the services and facilities of the Glenville State College, and further including any pre-existing physical
condition or impairment.

The undersigned, his or her heirs, personal representatives, executors, and assignees do hereby release and
discharge Glenville State College, its instructors, employees, servants, and agents from all claims, demands,
injuries, damages actions or causes of action and from all acts of active or passive negligence on the part of the
college, its servants, instructors agents or employees. The undersigned further agrees to abide by all policies and
procedures of Glenville State College, and, which policies and procedures may be posted at the facility, issued
orally and/or published, and which may be amended from time to time at management’s sole discretion.

Upon registering your child for camp, you as the parent/guardian hereby consent, permit, and authorize
Glenville State College and its affiliates, agents, employees, contractors, personnel, and others acting on their
behalf to use your child’s/children’s likeness, voice, and image in photographs, videotapes, sound recordings,
motion pictures, or other media materials (collectively referred to as “media materials”) which may be used for
promotional purposes, research, publicity, or other purposes deemed appropriate by Glenville State College. You
understand that your child/children’s photograph or likeness and voice may be copied and distributed by means
of various media, including video presentation, simultaneous use television, rebroadcast, radio distribution or
retransmission, news bulletins, press releases, billboards or signs, brochures, placement on GSC’s web sites, and
by other electronic delivery or publications. You acknowledge that Glenville State College has the right to make
one or more photographs, audio recordings, videotape or disk presentations, or other electronic reproduction of
your child’s image, voice, or performance in accordance with this agreement. You waive any right to inspect or
approve the finished product or any media materials in which Glenville State College may eventually use your
child’s photograph, likeness, or voice. You understand that all media materials are the property of Glenville State
College and relinquish any right, title, or interest in or to the media materials or the use made of them by Glenville
State College, including any copyright therein. You understand that your child’s name may or may not be included
in whatever credits are associated with the media materials and that your child’s likeness may or may not appear
in any media materials.

The parent/guardian will pay for any damages determined to have been caused by their child during the camp
within ten (10) days of the camp.

I have read the above statement and agree to the payment for services and policies for Glenville State College.

Parent/Guardian/Adult

Signature _____________________________________ Date: ______________

How did you hear about us?  Facebook  Repeat Pool Visitor
 Website  Newspaper  Family/Friend  Other:___________________________