Holiday Camp 2022 Registration – Credit Card Payment Parent / Guardian Name*FirstLast Home Address Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country Home Phone* Cell Phone* Emergency Contact Name*FirstLast Emergency Phone:* Email*Genesis Gymnastics Holiday Camp runs weekdays from December 26, 2022 to January 6, 2023. We are closed for statutory holidays. You may choose full days or half days in the morning or the afternoon, as well as before and after care as needed.Rates:Full day, 9am - 4pm: $58Half day, 9am - 12pm or 1pm - 4pm: $40 per half dayBefore Care is available 8am - 9am, $15After Care is available 4pm - 6pm, $15 / hour. Participant's Name*FirstLast Participant's Date of Birth* Participant's Gender*FemaleMale Does the participant have any special needs, allergies or medications?_______________________________ Full DayMonday, Dec. 26Tuesday, Dec. 27Wednesday, Dec. 28Thursday, Dec. 29Friday, Dec. 30Tuesday, Jan. 3Wednesday, Jan. 4Thursday, Jan. 5Friday, Jan. 6 Half Day:Tuesday, Dec. 27 MorningTuesday, Dec. 27 AfternoonWednesday, Dec. 28 MorningWednesday, Dec. 28 AfternoonThursday, Dec. 29 MorningThursday, Dec. 29 AfternoonFriday, Dec. 30 MorningFriday, Dec. 30 AfternoonTuesday, Jan. 3 MorningTuesday, Jan. 3 AfternoonWednesday, Jan. 4 MorningWednesday, Jan. 4 AfternoonThursday, Jan. 5 MorningThursday, Jan. 5 AfternoonFriday, Jan. 6 MorningFriday, Jan. 6 Afternoon Before or After Care:Tuesday, Dec. 27 Before CareTuesday, Dec. 27 After CareWednesday, Dec. 28 Before CareWednesday, Dec. 28 After CareThursday, Dec. 29 Before CareThursday, Dec. 29 After CareFriday, Dec. 30 Before CareFriday, Dec. 30 After CareTuesday, Jan. 3 Before CareTuesday, Jan. 3 After CareWednesday, Jan. 4 Before CareWednesday, Jan. 4 After CareThursday, Jan. 5 Before CareThursday, Jan. 5 After CareFriday, Jan. 6 Before CareFriday, Jan. 6 After CarePlease note you will be required to sign our Warranty And Consent Of Parent / Guardian, on your first day of camp. You may download and review it, CLICK HERE. I understand that I will be required to sign a waiver form in order for my athlete to participate. All rules and regulations will be adhered to as Genesis Gymnastics needs. My email will also be added to their mailing list for future contact. I will pay in full via Cheque or Cash in the gym. *I agreeSubmitReset