POWER CAMP - Summer School Break 2017

Please enter the following information in order to submit your child's camp registration.

Drop off Time: 9:30 am Pick-up Time: 4:00pm

For 5 days camp: $450/ Members | $480/ Non-members

For 3 days camp: $300/ Members | $360/ Non-Members

If to opt for less than 5 days, camp can be done 3 consecutive days. Indicate the dates your child will be attending.

Others

Parent or Guardian Information*

Address*

Mobile No.*

Office No.

Email*

In case of Emergency, please contact:*

Telephone No.*

Child No. 1 - Name*

Date of Birth*

Birth Cert/Passport No. *

Age as of 2017

Child No. 2 - Name

Date of Birth

Birth Cert/Passport No. *

Age as of 2017

Any other information we should be know about your child?

Are you a Power Kids Gym member?*

YES

Parent's Consent/ Waiver Release:

I give permission for my child to attend Power Kids Gym camps or field trips that involve travelling to other location. Please note that photographs and videos will be taken during the camps for marketing and publicity uses in our collateral, website and in social media, or in any third party publication. Please inform a member of staff if you wish to be exempted from his activity. I hereby absolve and release Power Kids Gym for any and all liability for any injuries or damages that may incurred by my child in the activities conducted by Power Kids Gym.

Insurance: I understand that for my child to participate in the camp programs, it is required that I pay $10 per child for insurance coverage.

I have read and agree to the waiver.*

Yes

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Phone: (65) 6333 8511