Tennis and Life Camps

2008 INFORMATION FORM

Return this form and your payment at least three weeks before your camp begins to:

Tennis & Life Camps, Gustavus Adoiphus College, 800 W College Ave., St. Peter, MN 56082.

Name__________________________________ E-mail ____________________________

Address___________________________________ City_______________ State_______

Parents’ names (for minors) ______________________________________ Zip _______

Home phone (_____ )_____________ Office phone (_____ )_____________ Cell phone(_____ )_____________

Person to contact in emergency:

Name_______________________ Relation____________ Telephone(_____ )_____________

MEDICAL INFORMATION: (Medical exam by physician not required)

Age_____ Date of Birth ___________ Sex _____________Height _______ Weight _____

Insurance Carrier ____________________________________________Policy #_________________

Serious illnesses in the last two years? ________ If so, what and when? __________________________

Medical conditions of which we should be aware___________________________________________

List of ALL allergies ______________________________________________________

Medications you will bring to camp __________________________________________

Are you diabetic? _____ Date of last tetanus shot____________ Date of last physical exam________

Your physician: Name_____________________________ Phone (_____ )_____________

Your dentist: Name________________________________ Phone (_____ )_____________

YOUTH ONLY:

1. Present school _______________________________ 2. High school graduation year _______

PREVIOUS ATTENDANCE:

How many summers have you attended Tennis and Life Camps? _______When? ‘77’78’79’80’81 ’82 ‘83’84’85’86’87’88’89’90’91 ‘92’93’94’95’96’97’98’99’00’01 ‘02’03 ’04 ’05 ’06 ‘07 (circle yrs. of attendance)

CONSENT:

I certify that the above information (regarding myself or my child) is correct, to the best of my knowledge. Also, I have read the Terms for Enrollment (on the back of this page), and I understand them and accept them as stated.

Signature (parent or guardian of minor) _____________________ Date_____________

ROOM PREFERENCE: (All rooms have two beds)

______ Roommate’s name (if known) _____________________________________

______ People I want to room near ___________________________________________

________________________________________________________________________

______ Single room preference ($30 extra charge)

(Please complete the reverse side)

TERMS FOR ENROLLMENT

1. Applications are not accepted unless accompanied by a deposit of $150. Fifty dollars of the deposit is refundable

until three weeks before the session begins.

2. Because the enrollment is limited we reserve the right to refund any application and to decline to accept or later

reject any participant.

3. No refund is made for late arrival or early departure.

4. Parents are required to sign the medical consent form and to advise the camp staff of ANY medical problems the

children have (or problems that they have if they themselves are enrolling)

5. The camp will operate on the highest safety standards. However, it does not assume liability for sickness, disease

or accidents. It can accept no responsibility for losses due to delay or changes in air or other transportation services,

sickness, weather, strikes, war quarantine, or other causes or be liable or be responsible in any way whatsoever for

any loss, injury or damage, however caused. The right is reserved to cancel any session.

6. We reserve the right to dismiss any student whose influence is detrimental to the camp. No refund will be given.

Any additional travel expense will be borne by the participant.

7. Any necessary clothing and equipment lists will be sent to the applicant before the session begins.

8. Temtis and Life Camps reserves the right to take, process, publish or otherwise use photographs, movies, and/or

videotapes of the applicant as deemed advisable by Tennis and Life Camps.

MEDICAL CONSENT (to be signed for ALL minors under age eighteen)

To Tennis and Life Camps re: __________________________________________ (a minor):

The undersigned is either the natural parent or legal guardian of the above named minor who is enrolled in you tennis school program. In the event medical or dental emergencies arise necessitating medical or dental treatment to the said minor, we hereby give you full power and authority to do and perform all and every act and thing whatsoever to all intents and purposes as we might or could do if personally present with full power of substitution, including but not limited to the signing of any all consents requisite or convenient to obtaining medical, dental or hospital treatment for such minor. You may rely upon the recommendation of any medical practitioner, dental practitioner, or agency furnishing hospital services in the event they advise you that such minor requires such medical, dental or hospital treatment on an emergency basis.

It is mutually agreed that this authorization shall be irrevocable, and any medical practitioner, dental practitioner, or agency furnishing hospital services may rely upon your executing all authorizations on our behalf.

It is further mutually agreed that you shall use your best efforts to notify us in the event of such medical, dental or hospital-type emergency.

Signature_________________________________________ Date ______________________

LIABILITY RELEASE (to be signed by all adult participants and by parents of junior participants)

Tennis and Life Camps maintains the highest safety standards. Nevertheless, vision can be impaired by an unanticipated ball hitting you in the eye. An ankle can be broken or sprained if you step on a stray tennis ball. A heart attack is possible if you push yourself beyond your limits and do not monitor your pulse.

Therefore each participant attending Tennis and life Camps assumes personal responsibility for his or her own health. Never will anyone be required to do something he or she deems unsafe. Encouragement by instructors or fellow students to accomplish a drill or game can be ignored by you. You remain responsible for your health and safety.

While at camps you may ride in a Gustavus Adolphus bus or van (used for transporting on campus only), may swim in the Gustavus Adolphus pool (supervised by Gustavus lifeguards), and eat in the Gustavus Adoiphus cafeteria (run by the school, not Tennis and Life Camps). If accidents should occur in non-tennis activities, Tennis and Life Camps is not responsible.

I hereby agree not to hold Tennis and Life Camps responsible for injuries or loss of health acquired while in attendance.

Signature _________________________________ Date ____________________________