Silver Stars Gymnastics Summer Camp Medical Form- 2008

Camper's Name: / DOB __/__/____ / Age ___ / Sex M/F
Address: / Home Phone:
City: / State: / Zip: / Grade in Fall:
Does camper attend school in: MD DC VA (Circle one) / Name of School:
Contact Information:
Parents name: / Work phone: / Cell phone:
Parents name: / Work phone: / Cell phone:
Emergency contact name(first & last):
Relation to Camper: / Emergency contact phone:
Medical Information:
Family Physician Name: / Physician's Phone #
Insurance Provider: / Insurance ID #
Any Operations, illnesses or injuries during the past school year:
Other limitations:
Any Allergies?...bee stings, food, etc
What treatment is required?
Date of last Tetanus immunization(this is required by the state) / _____/_____
Month/Year
Immunization Exemption-attach signed letter with reason for exemption
Prescription drug policy:
**Silver Stars will not dispense prescription medication. (EpiPens and Inhalers are not considered prescription medications.)
Liability and Medical Release Form:
I understand that any athletic activity is inherently dangerous. The above named student has had a medical examination within the last
twelve months and is capable of participating in gymnastics. In the event of injury or illness, every effort will be made to contact the
parent or guardian. If necessary, I authorize Silver Spring Gymanstics & Fitness Club, Inc. to administer first aid and/or authorize
medical treatment. Students are expected to carry their own accident and medical insurance. I agree to be responsible for any
medical bills incurred resulting from illness or injury during my child's participation at Silver Spring Gymanstics & Fitness Club, Inc.
By signing this release, I understand the policies and liabilities that may occur in sports activities.
(initial) / I understand there are no refunds or credits given. There is a $25 charge for any returned checks.
Photograph release: I agree to allow my child's likeness to be used on the website and in promotional
(initial) / materials for Silver Spring Gymanstics & Fitness Club, Inc.
Signature(parent/guardian) / Date
*If you did not register on line then return this form before June 1, 2008
date
Silver Spring Gymnastic & Fitness Club, Inc. / pmt
2701 Pittman Dr. Silver Spring, Md. 20910 / ch #
301-589-0938 / ck #
www.gosilverstars.com / immun form
camp form
bal due

Silver Stars Gymnastics Summer Camp Letter – 2008

Welcome Campers and / Parents:
Thank you for choosing to spend your summer with us. We are very excited about our summer
camp program and look forward to having you with us. This letter is to welcome you, remind you of what week(s)
you registered for and what to bring.
Drop-Off and Pick-up Policies:
*Full Day(FD) 8:30-4:30 / *Half day(HD) 9-noon / *Am Extended(AMX) 8am-8:30am / *PM Extended(PMX) 4:30-6pm
All paperwork and payments must be complete before your child is allowed to enter camp. If you
need to drop off special instructions, medical forms, etc. please make sure you arrive a few minutes early on
the first day to get this done. No camper will be allowed in unless all forms are complete and payments made.
Please be prompt when picking up your camper at the end of the day. If your child remains at camp past
their pick-up time, there will be an additional charge, half day campers will be charged for full day and full day
campers will be charged for extended care.
Payment Policies:
All balances are due by June 1, 2008. If you register after June 1, 2008 you are required to pay in full at the
time you register. You may phone-in payment by credit card weekdays from 9:30am-3:30pm 301-589-0937 ext 7. We
have a strict NO REFUND policy and you may not transfer monies to Fall classes. You may change weeks of camp if
space is available, however, there is a $50 change fee per week. Remember a camp week is only guaranteed when
registration and payment is made. You are paying for your child's spot in camp, not his/her attendance.
Camp Forms:
MARYLAND STATE LAW REQUIRES CAMPERS TO BE 3 1/2 YEARS OLD & POTTY TRAINED TO ATTEND.
Attached you will find a camp medical form, due June 1, 2008. Please check the information and
note any incorrect data and fill in the blanks. This form must be returned to us, completed, or your camper
will not be allowed to participate. If your child attends school in MD, the Summer Camp Form is the ONLY FORM
necessary. An immunization form is required ONLY if your child's school is outside of the state of MD.
You can ask your doctor's office to fax the immunization records directly to us at 301-589-1717.
***Silver Stars will not dispense prescription medications. (EpiPens and inhalers are not considered prescription meds.)
Full / Half / Amx / Pmx / Full / Half / Amx / Pmx
$250 / $190 / $25 / $50 / $250 / $190 / $25 / $50
June 9 – 13 / July 21 – 25
June 16 – 20 / July 28 – Aug. 1
June 23 – 27 / Aug. 4 – 8
June 30 – July 3* / Aug. 11 – 15
July 7 – 11 / Aug. 18 – 22
July 14 – 18 / Aug. 25 – 29
*Full Day(FD) 8:30-4:30 / *Half day(HD) 9-noon / *Am Extended(AMX) 8am-8:30am / *PM Extended(PMX) 4:30-6pm
Extended AM (8am – 8:30am) ______$25/Week. Extended PM (4:30pm – 6pm) ______$50/Week
2701 Pittman Drive, Silver Spring, Md. 20910
Phone: 301-589-0938 / Fax: 301-589-1717
E-Mail: / Tax Id #: 521844-208
www.gosilverstars.com

Silver Stars Gymnastics Summer Camp Recap – 2008

Camp Hours:
Full Day: 8:30am-4:30pm / Half Day: 9:00am-12:00pm
*Am Extended(AMX) 8am-8:30am / *PM Extended(PMX) 4:30-6pm
Please be prompt when picking up your camper at the end of the day. If your child remains at camp past
their pick-up time, there will be an additional charge, half day campers will be charged for full day and full day
campers will be charged for extended care.
Clothing:
Girls age 5 and older should wear a one-piece leotard. Boys must wear gym shorts
and T-shirts. No loose fitting clothes for safety reasons. No Jeans, no belts, no buckles. Please include
a change of clothes for younger campers for bathroom emergencies.
Please pull long hair back out of face in a rubber band. Send extra rubber bands if
necessary and please NO JEWELRY! NO WATCHES!
Optional: / You may send your child with a small carrying bag to hold their belongings.
Please do not send any valuables or money: we are NOT responsible for lost items!
Lunch:
Send a bag lunch with full day campers. We do not provide refrigeration or a microwave
for the children's lunches. Please send food accordingly.
Pizza ($2.00 per slice) and Soda (1.25 per bottle) must be ordered at drop off or by 10am.
All of our full day campers eat lunch together in the lunch area. We cannot separate any
individual child due to food allergies.
Medicine:
We adhere to the Maryland State Camp Self-Administration Medication Policies. We are
not permitted not to administer any medications. A trained staff member will oversee and supervise any medicine
taken by our campers, however we will not administer medicine to your child. The child must be old enough to
identify and administer medicine on their own.
EpiPens and Inhalers may be administered by our trained staff.
All medicines must be in original containers along with signed authorization offered below.
Bring sign off portion with medicine the first day of camp
All medicines and forms must be dropped off Monday morning and picked up Friday, the state does
not allow medicine storage over the weekend.
**Silver Stars Summer Camp Self-Administration Medicine Program**
Camper's Name:
Home Phone:
Camp Week(s)
Written authorization for the Self-Administration of the medicine is given by the parent which includes:
**Parent Name:
**Parent Signature: / Date:
Name of Medicine:
Reason for Medicine:
Documentation that at least one dose of the medicine was given prior to the student arriving at camp:
Parent Signature:
(I confirm that I have given my child the first dose of this mediciation at home)