METRO CAMPSPORTS AND ENRICHMENT SUMMER CAMP

908-753-7777

at Rutgers University

METRO CAMP

SPORTS AND ENRICHMENT CAMP

AT RUTGERS UNIVERSITY -- BUSCH CAMPUS -- SONNY WERBLIN REC CTR. 656 BARTHOLOMEW RD., PISCATAWAY NJ


METRO CAMP

925 WEST 7TH ST.

PLAINFIELD, NJ 07063

FAX : (908)548-8877

PHONE : (908)753-7777

METROCAMP.NET@GMAIL.COM



LAST NAME __________________________________________FIRST NAME___________________________________BOY_______GIRL_______

ADRESS________________________________________________________________________________________________APT #____________________

CITY___________________________________________________STATE____________________________________ZIP_____________________________

CELL PHONE_______________________________________________________HOME PHONE_____________________________________________

MOTHERS NAME________________________________________________FATHERS NAME____________________________________________

EMERGENCY CONTACT INFO _________________________________________________________________________________________________

CHILDS AGE_____________DOB___________________SCHOOL __________________________________________________GRADE___________

HEALTH INSURANCE CARRIER_______________________________________POLICY OR GROUP #_______________________________


HEALTH AND BEHAVIOR GUIDELINES:

I, THE UNDERSIGNED, SUBMIT MY CHILD IS PHYSICALLY AND MENTALLY FIT TO PARTICIPATE IN STRENUOUS ATHLETIC ACTIVITY AND WAIVE

METRO CAMP AND RUTGERS  UNIVERSITY OF ANY AND ALL RESPONSIBILITY FOR INJURY OR ILLNESS. I HEREBY AUTHORIZE THE DIRECTORS

OF METRO CAMP AND RUTGERS  UNIVERSITY TO ACT FOR ME ACCORDING TO THEIR BEST JUDGEMENT IN ANY EMERGENCY REQUIRING 

MEDICAL ATTENTION. I UNDERSTAND THAT I AM SOLELY RESPONSIBLE FOR PAYMENT OF ANY SUCH MEDICAL EXPENSES AND I MUST PROVIDE

PROOF OF MEDICAL AND ACCIDENT INSURANCE. I ALSO UNDERSTAND MY PAYMENTS ARE NON-REFUNDABLE AND NON-TRANSFERABLE UNDER

ANY CIRCUMSTANCES. ANY CAMPER WHO DOES NOT ABIDE BY CAMP OR FACILITY RULES IS SUBJECT TO DISMISSAL WITHOUT REFUND OR RECOURSE.


SIGNATURE______________________________________________________________________________________________DATE___________________________________
























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