Summer 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 Summer Camp runs weekdays from July 4th, 2023 to September 1st, 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, $260 (5 day week), $208 (4 day week) or $58 per day.Half day, 9am - 12pm or 1pm - 4pm, $180 (5 day week) or $144 (4 day week), or $40 per half day.Before 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?_______________________________ July 4– 7 (4 days) (4-day holiday) 4 Full Days, 9am - 4pm4 Half Days, Mornings 9am - 12pm4 Half Days, Afternoons 1pm - 4pmTuesday Full DayWednesday Full DayThursday Full DayFriday Full DayTuesday Morning 9am - 12pmWednesday Morning 9am - 12pmThursday Morning 9am - 12pmFriday Morning 9am - 12pmTuesday Afternoon 1pm - 4pmWednesday Afternoon 1pm - 4pmThursday Afternoon 1pm - 4pmFriday Afternoon 1pm - 4pm Please check if you would like before or after care (July 4th - 7th). We'll follow up with you!Please contact me.Please 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 agree Total StripeSubmitReset