Camp Registration

Camper's Name

First

Last

Camper's Date of Birth

Last Level Camper Competed In

If camper has not competed previously, please put N/A

Camper Club Gym Name

Month/Year of Camper's Anticipated High School Graduation

Camper T-Shirt Size

Parent/Guardian Name

First

Last

Parent/Guardian Email

Parent/Guardian Phone

Parent/Guardian Address

Address Line 1

Address Line 2

City

State

Zip Code

1st Emergency Contact Name

First

Last

1st Emergency Contact Phone Number

1st Emergency Contact Relationship to Camper

2nd Emergency Contact Name

First

Last

2nd Emergency Contact Phone Number

2nd Emergency Contact Relationship to Camper

Health Insurance Provider

N/A if none

Health Insurance Policy Number

Name of Health Insurance Policy Holder

Health Insurance Group Number

Medical Conditions (N/A if none)

Please list any medical conditions that your camper has that camp medical staff should be aware of (i.e. asthma, heart murmurs, seizures, etc.)

Food Allergies (N/A if none)

Please list any food allergies that the camper has.

Other Allergies (N/A if none)

Please list any other (non-food related) allergies that the camper has.

Medication Information (for residential campers only) N/A if none

Please let all medications that the camper will need to take while at camp as well is their medication schedule.

Camper 1st Number

Medication Authorization

I authorize camp medical staff to administer Tylenol or Ibuprofen to my camper.
I do not authorize camp medical staff to adminster Tylenol or Ibuprofen to my camper.

Roommate Requests (for residential campers only)

We will do our best to honor roommate requests, but cannot guarantee that every request can be fulfilled.

Transportation

Camper will need to be picked up and/or dropped off at CMI

You will be contacted to arrange transportation. Camp staff can only provide transportation to and from the Champaign airport (CMI).

Signature

Clear Signature

By adding your signature, you confirm that you have read the liability waiver, authorization for medical care, health insurance information, and cancellation policy (located on the Pricing page) and agree to the terms laid out in each.

Camp Fees (please select the camp/s that your gymnast will attend)

Camp 1 (July 5th-7th) Resident (staying in the dorm) – $699.00 + processing fees – $720.00
Camp 1 (July 5th-7th) Commuter (dropped off and picked up each day)– $599.00 + processing fees – $615.00
Camp 2 (July 8th-10th) Resident (staying in the dorm)– $699.00 + processing fees – $720.00
Camp 2 (July 8th-10th) Commuter (dropped off and picked up each day)– $599.00 + processing fees – $615.00
Camp 1 & 2 (July 5th-10th) Resident (staying in the dorm)– $1,398.00 + processing fees – $1,440.00
Camp 1 & 2 (June 20th-25th) Commuter (dropped off and picked up each day)– $1,198 + processing fees – $1,230.00

Total

$0.00

Credit Card