Lionhearts Fitness Day Camps
Lionhearts Fitness
LionheartsFitness.com
Camper's Information
Member ID
Camper Name
*
Nickname
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Age
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.
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Parents' Information
Parent/Guardian 1
Parent/Guardian 1
*
First Name
Last Name
Relationship to Child
*
E-mail
*
Phone
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent's Work/School Name
*
Or enter N/A if not applicable
Parent's Work/School Phone
Where would you like to be reached while your child is at camp?
*
Cell Phone
Work Phone
Home Phone
Additional Parental Information
Parent/Guardian 2
Relationship to Child
Parent/Guardian 2
First Name
Last Name
E-mail
Phone
Home Address Same as Parent/Guardian 1?
Yes
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent's Work/School Name
Or enter N/A if not applicable
Parent's Work/School Phone
Parent's Work/School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Where would parent/guardian 2 like to be reached while your child is at camp?
Cell Phone
Work Phone
Home Phone
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Emergency Contacts/Authorized Pickup
Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Emergency Contact #1
Full Name
*
First Name
Last Name
Primary Phone Number
*
Secondary Phone Number
Relationship to Child
*
Emergency Contact #2
Full Name
*
First Name
Last Name
Primary Phone Number
*
Relationship to Child
*
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Please list and explain any allergies
0/150
Does your child have any food, medication or environmental allergies?
Yes
No
Allergies? Check all that apply
Food
Medication
Environmental
Does your child have a special health or medical condition?
*
Yes
No
Please explain
0/150
Is your child currently using any medication, food supplement or medical food (such as electrolyte solution)?
Yes
No
Please explain
0/150
Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?
*
Yes
No
Does this dietary restriction require a modified diet that eliminates all types of fluid milk or an entire food group?
Yes
No
List any additional information about your child that would be useful for staff to know, such as fears, eating or sleeping habits, or special routines. This information should not be medical or health related, as that information should be included in the previous questions.
0/200
Check all that apply WEDO NOT ADMINISTER ANY MEDICATION OR APPLY SUNSCREEN
Prescription medication
Nonprescription medication
Refrigeration required
Topical product or lotion
Topical product or lotion
Food supplement
Modified diet
For the following period of time
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Payment and Statement of Understanding
Lionhearts Fitness has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.
*
Type first and last name above to consent
This form, after being completed and signed by the parent/guardian, must be reviewed for completeness and signed by the administrator/designee prior to the child receiving care. After the child is attending the program the administrator shall have the parent/guardian review and initial the form when any changes/updates are made and at least annually. The parent/ guardian and the administrator or designee shall initial and date the form in the section below to indicate when the form was last reviewed. Additional Forms at : http://LionheartsFitness.com/Parents with necessary handbook and information for download
*
Type first and last name above to consent
Acknowledgement of Policies and Procedures I have reviewed and received a copy of the Lionhearts Fitness policies and procedures/handbook.
*
Yes
No
Sign Document
*
Date Signed
*
-
Month
-
Day
Year
Date Picker Icon
Email
example@example.com
Camp Director Name and Contact Info
My Products
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Week 1 Summer Camp Lionhearts Center
$
Free
SUGGESTED DONATION $150 but it's FREE unless you can donate 6/3-7
Week 2 Summer Camp WILLOW TREE
$
Free
SUGGESTED DONATION $150 but it's FREE unless you can donate
Week 3 Summer Camp WILLOW TREE
$
Free
SUGGESTED DONATION $150 but it's FREE unless you can donate
Week 4 Summer Camp 3 Lionhearts
$
Free
SUGGESTED DONATION $150 but it's FREE unless you can donate
Week 5 Summer Camp Elsie Holmes
$
Free
SUGGESTED DONATION $150 but it's FREE unless you can donate
Week 6 Summer Camp 4 WILLOW TREE
$
Free
SUGGESTED DONATION $150 but it's FREE unless you can donate
Week 7 Summer Camp Lionhearts
$
Free
SUGGESTED DONATION $150 but it's FREE unless you can donate 6/3-7
FINAL Week of CAMP 2024 Elsie Holmes
$
Free
SUGGESTED DONATION $150 but it's FREE unless you can donate
Total
$
0.00
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All Camps include daily fitness, drills, life skills and community building.
I understand
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