Technique Camps Registration

*This is the registration form for The Race Club’s TECHNIQUE CAMPS. To register for the TRAINING CAMP, please click on this link.

Choose one:

Call 877-SWIM-RACE to schedule a camp
Email: save registration form in PDF format and send to info@theraceclub.net
Fax: print out form and fax to (305) 852-4947
Mail: print out form and mail to: The Race Club 151 Kahiki Dr., Tavernier, FL 33070

Email: info@theraceclub.net
Phone: 877-SWIM-RACE
Fax: 305-852-4947
Office: 305-469-5500
Mail:
The Race Club
151 Kahiki Dr.
Tavernier, FL 33070

2009 – 2010 Technique Swim Camp
Name:
Home Address:
City:
State:
Zip:
Home Phone:
Office Phone:
Mobile Phone:
Fax:
Email:
Occupation:
Sex:	Male Female
Birthdate:
In order to burn your Dartfish stroke analysis CD correctly, we need to know if you use a PC or Mac computer ? PC Mac
Swim camp will begin on:	(Please specify if you will begin with the AM or PM session)
Swim camp will end on:	(Please specify if you will end with the AM or PM session)
Total number of sessions:	(There are a total of 2 sessions offered per day, 7 days a week)
How did you hear about us ?
Friend (name)
Coach (name and club
Magazine (name)
Internet (what were search key words?)
Other (specify)
Billing Information
For Credit Card Payments
Name on Credit Card:
Billing Address:
City:	State:		Zip:
Phone:
Email Address:
Credit Card #:
Card Type: VISA Mastercard
Expiration:
Deposit is $100 per athlete.
Refund Policy & Special Notes
The Race Club reserves the right to cancel all, or any portion of, the camp program due to weather, acts of God, or any other reasons within or beyond it’s control. A $100 deposit fee is taken at the time of registration and is non-refundable unless The Race Club cancels a camp due to unforeseen circumstances. Any cancellation made 8 days or more prior to the start of the camp will be charged 10% of the total cost of the camp, and may be used as credit toward a future camp. Any cancellation made 7 days or less prior to the start of the camp will be charged 50% of the total cost of the camp, and may be used as credit toward a future camp. In order to protect their camp investment against loss of camp tuition due to injury, illness, or other covered circumstance, campers are encouraged to purchase travel insurance. The camp does not provide coverage. Go to www.insuremytrip.com to create your own personal insurance policy and get insurance quotes from different insurers.
Release and Waiver of Liability
I hereby hold The Race Club and its staff free from all liability should any injury or illness befall me while I am in attendance at The Race Club Camp. I also authorize The Race Club Staff to secure medical treatment for me should I not be able to request such treatment for myself. I have no knowledge of any existing physical impairment that would affect my participation in this program. In addition, I authorize The Race Club to use any photographs of me taken during the program for use in publicizing and advertising future Race Club Swim Camps.
Print Name:
Signature:			Date:
Signature of Parent/Legal Guardian (if under 18 years):
Health Plan Name:			Plan ID:
Emergency Contact Person:			Phone:
Parental Medical Information and Consent Form
Please read the following information carefully before signing. As the parent(s) or legal guardian(s), I certify that has my permission to participate at The Race Club Camp for the period of at . I do hereby delegate to The Race Club, it’s employees, clinicians, trainers, nurses, agents, or representatives, the authority to seek, obtain, and approve any medical care and treatment including, but not limited to x-ray examination, anesthetic, medical, dental, or surgical diagnosis, or treatment and medical care which is deemed advisable by, and is to be rendered under the general supervision of any physician or surgeon, for my child which, in their judgment, is necessary for the health and well-being of my child during his/her participation at The Race Club Camp. I accept responsibility for medical charges, which may be incurred on my child’s behalf. It is understood that this authorization is given in advance of any specific diagnosis, or treatment, or medical care being required and is to serve as specific consent to any and all such diagnoses, treatment, or hospital care which may be deemed advisable. I understand that I am responsible for any cost incurred that is not covered by insurance and I agree to hold The Race Club, it’s employees, officers, representatives, and agents harmless for any liability arising out of any good faith effort taken in and obtaining medical treatment for my child. I hereby give consent and permission to The Race Club to authorize medical treatment for: (Child’s Name)
Print Name of Parental/Legal Guardian:
Parental/Legal Guardian Signature:			Date:
Print Name of Parental/Legal Guardian:
Parental/Legal Guardian Signature:			Date:
Medical Information
Camper’s Name:
Age:		Date of Birth:
Parent/Legal Guardian Name(s):
Address:
City:	State:		Zip:
Home Phone:
Work Phone:
Mobile Phone:
Other Phone:
Emergency Contact (if unable to reach Parent/Legal Guardian):

Relationship to Camper:
Phone:
Family insurance policies shall be responsible for covering any and all injuries sustained by camp participants. Therefore, it is necessary that you include your insurance information below.
Insurance Company:
Policy #:
Policy Holder’s Name:
Policy Holder’s Address:
Child’s Primary Physician:
Primary Physician Phone:
Please list any concerns/limitations that may affect your child’s camp experience:


Is your child on any medication? If yes, please list medication:


Camper Information
1) What are your expectations from the camp ?

2) How many hours per week do you swim ?

3) What is your typical workout like ?

4) What are your personal best times of your best events ?

5) Are you training for a particular competition or purpose ?

6) Is there anything else we should know about? Do you have any special requests ?

Don’t forget to clear your information once you printed the form.

The Race Club

Technique Camps Registration

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