SPOTSYLVANIA COUNTY PARKS AND RECREATION P.O. BOX 28 SPOTSYLVANIA, VIRGINIA 22553 LORIELLA PARK, 10910 LEAVELLS RD FREDERICKSBURG, VIRGINIA 22407 540-507-PLAY (7529) www.spotsylvania.va.us/parksandrec
TA B L E O F C O N T E N T S General Information.. 3 Baseball. 5 Boys Basketball 5 Coed Basketball.. 5 Girls Basketball... 5 Cross Country. 6 Field Hockey... 6 Football. 6 Lacrosse... 7 Physical Education Games.. 7 Coed Soccer... 7 Girls Soccer. 7 Softball. 8 Sports and Motor Skills... 8 Track and Field.. 8 Volleyball. 8 Wrestling. 9 Cheerleading... 9 Engineering for Kids.. 9 Freshwater Fishing.. 10 Horseback Riding.. 10 Music Lessons 10 The 7 Habits of Successful Teens. 11 Tennis.. 11 Sports Camp Calendar. 13 Leisure Camp Calendar 14 Camp Registration Form 15
G E N E R A L I N F O R M AT I O N 3 PURPOSE: The Spotsylvania Parks and Recreation Department s Camps are designed to teach children the fundamentals of each particular activity. Participants register according to their age and are grouped according to skill levels (for sports camps), at the instructor s discretion. Age waiver forms are available to move your child up one year older to the next age group for sports camps only (with the exception of Tennis). REGISTRATION: To register, complete the separate registration form and return it along with the fee and a copy of your child s birth certificate (if one is not already on file with the department) to the Parks and Recreation Department. Each participant will receive a t-shirt, which they may keep (sport camps only no t-shirt for arts, music camps, Engineering for Kids camps, fishing camps, horseback riding camps, 7 Habits of Successful Teens, or advanced football camps). Please indicate your child s shirt size on the form. Please make your check payable to: Treasurer, Spotsylvania County. There will be a $50.00 service charge on all returned checks. 2.95% NON-REFUNDABLE CONVENIENCE FEE CHARGED ON ALL CREDIT/DEBIT CARD TRANSACTIONS. Online registration is available if a Household Liability Waiver is on file at the Parks and Recreation Department. Register at www.spotsylvania.va.us/parksandrec. REGISTRATION DEADLINE: Registration will end when the camp fills or on the listed deadline for the camp. Late registrations will be accepted, provided space is available. There will be an additional fee of $10.00 on all late registrations. Space in each camp is limited early registration is suggested. CAMP TRANSFERS: Request for camp transfers may be made up to one week prior to the starting date of the activity, subject to space availability. All transfers must be made in person. A transfer request form must be completed and signed before a transfer can be made. There will be a fee of $5.00 for each transfer made. WITHDRAWALS: Those wishing to withdraw from a camp must do so by contacting the Spotsylvania Parks and Recreation Department at least one week prior to the start of the camp. Individuals must follow up their verbal cancellation request with a written refund request. A 20% administrative fee will be charged on all refunds. The 2.95% NON- REFUNDABLE CONVENIENCE FEE paid for credit/debit card registration will not be refunded. Failure to attend the camp does not constitute proper withdrawal, and the participant will not receive a refund. There will be no refunds given to those who withdraw You will not receive a call to confirm your camp. It is your responsibility to see that your child attends camp. We will only notify you if the camp is canceled due to lack of enrollment.
4 G E N E R A L I N F O R M AT I O N INCLEMENT WEATHER: Cancellations due to inclement weather can be heard by calling our cancellation line at 540-898-8546 and/or by signing up for alerts to be received through emails, text messages, or your pager at www.spotsyalert.com. Cancellations will be available as soon as a decision is made to cancel. Please listen to the message carefully. If weather conditions are questionable and you do not hear or receive a cancellation announcement, you should report for your camp. ***Spotsylvania Alert System*** Register to receive timely alerts and emergency notifications from the county concerning severe weather, Amber alerts, local emergencies, Homeland Security Alerts, and County Government Information. The Parks and Recreation Department notifications include: Leisure/Special Event Cancellations Pool Information Program/Special Event Information Sports Cancellations Volunteer Opportunities These alerts can be received through e-mails, text messages, or pages. To register visit www.spotsyalert.com SPORTS CAMP NECESSITIES Bring a thermos with a drink water will be available. Wear shorts, t-shirt, and tennis shoes, unless otherwise noted. Baseball/Softball: Bring a glove and a pair of sweatpants. Soccer: Wear shin guards and bring a soccer ball marked with the child s name. If your child does not already have a ball, and you are buying one, use the following guideline: Ages 6-7 Size 3;Ages 8-9 Size 4; Ages 10-13 Size 5. Field Hockey: Bring a stick and shin guards Lacrosse: Must bring a stick, gloves, and tennis shoes (if a stick is needed, contact Becky Weber by email rufus34@comcast.net).
S P O R T S C A M P S 5 BASEBALL AGES: 7 12 DATES: July 25 July 28, 2016 (M-TH) TIME: 6:00pm 8:30pm LOCATION: Loriella Park INSTRUCTOR: Tim Acors ACTIVITY #: 130301-01 DEADLINE TO REGISTER: July 15, 2016 AGES: 7 12 DATES: June 27 June 30, 2016 (M-TH) LOCATION: Loriella Park INSTRUCTOR: Chris Stowe FEE: $60.00/$70.00 RES/NON ACTIVITY #: 130301-02 DEADLINE TO REGISTER: June 17, 2016 BOYS BASKETBALL AGES: 7 9 DATES: July 18 July 22, 2016 (M-F) LOCATION: Riverbend High School INSTRUCTOR: Wayne Via FEE: $60.00/$70.00 RES/NON ACTIVITY #: 130501-01 DEADLINE TO REGISTER: July 8, 2016 AGES: 10-16 DATES: July 11 July 15, 2016 (M-F) TIME: 6:00pm 9:00pm LOCATION: Riverbend High School INSTRUCTOR: Nat Jackson FEE: $60.00/$70.00 RES/NON ACTIVITY #: 130501-02 DEADLINE TO REGISTER: July 1, 2016 COED BASKETBALL AGES: 7 9 DATES: July 18 July 21, 2016 (M-TH) TIME: 6:00pm 8:30pm LOCATION: Chancellor High School INSTRUCTOR: Rob Reich ACTIVITY #: 130501-03 DEADLINE TO REGISTER: July 8, 2016 GIRLS BASKETBALL AGES: 7 9 DATES: July 18 July 22, 2016 (M-F) LOCATION: Riverbend High School INSTRUCTOR: Wayne Via FEE: $60.00/$70.00 RES/NON ACTIVITY #: 130601-01 DEADLINE TO REGISTER: July 8, 2016 AGES: 10 16 DATES: July 18 July 22, 2016 (M-F) LOCATION: Chancellor High School INSTRUCTOR: William Griffin FEE: $60.00/$70.00 RES/NON ACTIVITY #: 130601-02 DEADLINE TO REGISTER: July 8, 2016
6 S P O R T S C A M P S CROSS COUNTRY AGES: 13 18 DATES: June 27 July 15, 2016 (M-F) TIME: 7:45am 10:00am LOCATION: Loriella Park INSTRUCTOR: Nate Brooks FEE: $175.00/$185.00 RES/NON ACTIVITY #: 130402-01 DEADLINE TO REGISTER: June 17, 2016 FIELD HOCKEY AGES: 7 14 DATES: June 20 June 23, 2016 (M-TH) TIME: 5:30pm 8:00pm LOCATION: Courtland High School INSTRUCTOR: Courtland High School Staff ACTIVITY #: 134202-02 DEADLINE TO REGISTER: June 10, 2016 FOOTBALL ADVANCED CHARGER AGES: Rising 7th 12th graders DATES: July 26 July 29, 2016 (T-F) TIME: 6:00pm 9:00pm LOCATION: Chancellor HS Practice Field INSTRUCTOR: Chancellor High School Staff ACTIVITY #: 131701-02 DEADLINE TO REGISTER: July 15, 2016 FOOTBALL ADVANCED COUGAR AGES: Rising 9th 12th graders DATES: July 25 July 27, 2016 (M-W) TIME: 6:00pm 8:30pm LOCATION: Courtland HS Practice Field INSTRUCTOR: Courtland High School Staff ACTIVITY #: 131701-03 DEADLINE TO REGISTER: July 15, 2016 FOOTBALL ELEMENTARY INTRODUCTION TO FUNDAMENTALS AGES: 6 10 DATES: July 18 July 21, 2016 (M-TH) TIME: 6:00pm 8:30pm LOCATION: Battlefield Middle School Field INSTRUCTOR: Chris Lam ACTIVITY #: 131701-05 DEADLINE TO REGISTER: July 8, 2016 FOOTBALL QUARTERBACKS & WIDE RECEIVERS AGES: 8 13 LOCATION: Loriella Soccer Field #2 DATES: July 19 July 21, 2016 (T-TH) TIME: 6:00pm 8:30pm INSTRUCTOR: Ryan Hall FEE: $45.00/$55.00 RES/NON ACTIVITY #: 131701-04 DEADLINE TO REGISTER: July 8, 2016
S P O R T S C A M P S 7 FOOTBALL YOUTH AGES: 8 13 DATES: July 12 July 15, 2016 (T-F) TIME: 5:30pm 8:00pm LOCATION: Battlefield Middle School Field INSTRUCTOR: Battlefield MS Staff ACTIVITY #: 131701-01 DEADLINE TO REGISTER: July 1, 2016 LACROSSE (COED) AGES: 5 13 DATES: July 5 July 8, 2016 (T-F) LOCATION: Loriella Park INSTRUCTOR: Spotsy Ravens Coaching Staff FEE: $45.00/$55.00 RES/NON ACTIVITY #: 130801-01 DEADLINE TO REGISTER: June 24, 2016 PHYSICAL EDUCATION GAMES AGES: 6-10 DATES: June 28 July 1, 2016 (T-F) LOCATION: Smith Station Elementary School INSTRUCTOR: Chris Lam ACTIVITY #: 130701-03 DEADLINE TO REGISTER: June 17, 2016 COED SOCCER AGES: 6 10 DATES: June 20 June 23, 2016 (M-TH) LOCATION: Loriella Park INSTRUCTOR: Chancellor High School Staff ACTIVITY #: 133201-01 DEADLINE TO REGISTER: June 10, 2016 AGES: 4 6 DATES: June 27 June 30, 2016 (M-TH) TIME: 6:00pm 8:00pm LOCATION: Patriot Park INSTRUCTOR: Len Carlson FEE: $40.00/$50.00 RES/NON ACTIVITY #: 133201-02 DEADLINE TO REGISTER: June 17, 2016 GIRLS SOCCER AGES: 8 13 DATES: July 11 July 14, 2016 (M-TH) TIME: 9:00am 11:30am LOCATION: Patriot Park INSTRUCTOR: Len Carlson ACTIVITY #: 133201-03 DEADLINE TO REGISTER: July 1, 2016
8 S P O R T S C A M P S SOFTBALL AGES: 8 10 DATES: August 1 August 4, 2016 (M-TH) TIME: 5:30pm-7:30pm LOCATION: Courtland HS Softball Field INSTRUCTOR: Courtland High School Staff FEE: $45.00/$55.00 RES/NON ACTIVITY #: 130303-01 DEADLINE TO REGISTER: July 22, 2016 AGES: 11-14 DATES: August 1 August 4, 2016 (M-TH) TIME: 7:30pm-9:30pm LOCATION: Courtland HS Softball Field INSTRUCTOR: Courtland High School Staff FEE: $45.00/$55.00 RES/NON ACTIVITY #: 130303-02 DEADLINE TO REGISTER: July 22, 2016 SPORTS AND MOTOR SKILLS AGES: 4 6 DATES: August 1 August 5, 2016 (M-F) TIME: 9:00am 11:00am LOCATION: Chancellor Elementary School INSTRUCTOR: Wayne Via FEE: $35.00/$45.00 RES/NON ACTIVITY #: 130701-01 DEADLINE TO REGISTER: July 22, 2016 AGES: 4 6 DATES: August 1 August 5, 2016 (M-F) TIME: 12:00pm 2:00pm LOCATION: Chancellor Elementary School INSTRUCTOR: Wayne Via FEE: $35.00/$45.00 RES/NON ACTIVITY #: 130701-02 DEADLINE TO REGISTER: July 22, 2016 TRACK AND FIELD AGES: 9 14 DATES: June 20 23, 2016 (M-TH) LOCATION: Courtland High School Track INSTRUCTOR: Courtland High School Staff ACTIVITY #: 473801-21 DEADLINE TO REGISTER: June 10, 2016 VOLLEYBALL AGES: 11 14 DATES: July 12 July 14, 2016 (T-TH) TIME: 6:00pm 9:00pm LOCATION: Riverbend High School INSTRUCTOR: Jack Lindblad FEE: $45.00/$55.00 RES/NON ACTIVITY #: 134001-01 DEADLINE TO REGISTER: July 1, 2016 AGES: 6 10 DATES: July 12 July 14, 2016 (T-TH) TIME: 6:00pm 9:00pm LOCATION: Riverbend High School INSTRUCTOR: Jack Lindblad FEE: $45.00/$55.00 RES/NON ACTIVITY #: 134001-02 DEADLINE TO REGISTER: July 1, 2016
S P O R T S & L E I S U R E C A M P S 9 WRESTLING AGES: 6 13 DATES: July 25 July 28, 2016 (M-TH) LOCATION: Riverbend High School INSTRUCTOR: William Etcho ACTIVITY #: 134201-01 DEADLINE TO REGISTER: July 15, 2016 CHEERLEADING AGES: 6 14 DATES: August 8 August 12, 2016 (M-F) TIME: 4:00pm 6:00pm LOCATION: Chancellor High School Gym INSTRUCTOR: Chancellor Cheerleading ACTIVITY #: 131201-15 DEADLINE TO REGISTER: July 29, 2016 ENGINEERING FOR KIDS Register for Engineering for Kids camps online at www.engineeringforkids.com/centralva. Jr. Robotics: Simple Machines We use machines everyday, but many times without even recognizing them. In Junior Robotics: Simple Machines, students will explore the basic concepts of simple machines and how we use them to achieve even our most grandiose goals! Students will use LEGO WeDo construction and resource kits to produce new and exciting builds that will be used to create Kelvin s Amusement Park. AGES: 5 7 DATES: July 5 July 8, 2016 (T-F) LOCATION: Marshall Center Band Room INSTRUCTOR: Engineering for Kids Staff TIME: 9:00am 11:30am FEE: $140.00 3-D Printing Minecraft 3-D printing and Minecraft both represent boundless opportunity for creating even our wildest of ideas! In 3-D Printing: Minecraft, students will explore the basic concepts of 3-D printing and computer-aided design, or CAD, to bring their most awesome Minecraft creation to life! Students will take their Minecraft design out of the world of Minecraft and learn how to extrude it into a 3-D model that can then be modified to be printed in 3-D. AGES: 7-12 DATES: August 1 August 5, 2016 (M-F) LOCATION: Marshall Center Band Room INSTRUCTOR: Engineering for Kids Staff FEE: $175.00 Robotics: Robot Olympics using EV3 LEGO Robots During the LEGO Robotics Olympics camps, students design and program robots to compete in simulated Olympic events such as a sprinting in a race, tug of war, basketball, hockey, and sumo wrestling.. Students use LEGO Robotics and computers to learn principles of robotics, computer programming, and teamwork while having an amazing time! AGES: 8 12 DATES: August 8 August 12, 2016 (M-F) LOCATION: Marshall Center Band Room INSTRUCTOR: Engineering for Kids Staff FEE: $165.00
10 L E I S U R E C A M P S FRESHWATER FISHING The Adventure Fishing Camp is a weeklong fishing camp sponsored by Virginia Fishing Adventures (www.virginiafishingadventures.com). The camp is designed to teach the entire process of fishing from rigging rods, tying knots, canoeing, and baiting hooks, all while introducing campers to the great wealth of fishing opportunities the area has to offer. Campers will meet at the Virginia Outdoor Center where we will load into cars and head to a mixture of private ponds as well as the Rappahannock and Rapidan Rivers, giving kids several nice floats during the week. Scouts may also earn their fishing merit badge. All equipment provided. Contact Tee Clarkson with questions: tsclarkson@virginiaoutside.com or 804-272-6362. AGES: 7 14 DATES: July 18 July 22, 2016 (M-F) LOCATION: Virginia Outdoor Center INSTRUCTOR: Virginia Adventures Staff TIME: 8:30am 4:30pm FEE: $450.00 ACTIVITY #: 112101-11 DEADLINE TO REGISTER: July 8, 2016 HORSEBACK RIDING AGES: 6 12* DATES: July 11 July 15, 2016 (M-F) LOCATION: White Buffalo Horse Farm INSTRUCTOR: Judy Watson FEE: $305.00 ACTIVITY #: 201211-22 DEADLINE TO REGISTER: July 1, 2016 Students of Horseback Riding are required to wear shoes or boots with a small heel and long jeans or pants. MUSIC LESSONS DJ Quick Start This class will cover the benefits of becoming a DJ, tools they will need and how to set them up, how to choose and use a DJ program, music history, recognizing pop music and artists from the 40s to the present, how to target audiences and create set lists around their preference in music, what kind of events they will need to prepare for, being professional, and announcing. All camp materials will be provided, however, campers are encouraged to, but not required to, bring his or her personal laptop or ipad AGES: 12 17 DATES: June 23 July 14, 2016 (Thursdays) LOCATION: Marshall Center Room C INSTRUCTOR: Michael Geddes TIME: 11:00am 12:30pm FEE: $150.00 ACTIVITY #: 112402-01 DEADLINE TO REGISTER: June 10, 2016 Guitar * AGES: 8 12 DATES: June 28 July 19, 2016 (Tuesdays) TIME: 11:00am 11:50am LOCATION: Marshall Center Room C INSTRUCTOR: Michael Geddes FEE: $75.00 ($9.00 workbook fee collected 1st class) ACTIVITY #: 112402-02 DEADLINE TO REGISTER: June 17, 2016 Participants must provide his/her own instrument. Please contact Michael Geddes for more information mgpmuzic@verizon.net.
L E I S U R E C A M P S 11 THE 7 HABITS OF SUCCESSFUL TEENS This 2 day workshop combines instruction along with videos and hands-on activities as it introduces students to the world of personal development and leadership in a fun and relaxed way. Each of the 7 Habits are introduced, explored, and discussed. The 7 Habits: Be Productive; Begin with the End in Mind; Put First Things First; Think Win-Win; Seek First to Understand, then to be Understood; Synergize; Sharpen the Saw. AGES: 13 18 DATES: July 14 July 15, 2016 (TH-F) LOCATION: Marshall Center Room C INSTRUCTOR: Carla Geddes TIME: 12:30pm 4:00pm FEE: $65.00 ACTIVITY #: 363401-02 DEADLINE TO REGISTER: July 1, 2016 MUNCHKIN TENNIS Racquets are provided for ages 6 7. No Age Waivers Accepted. AGES: 6 7 DATES: June 20 June 23, 2016 (M-TH) TIME: 11:00am 11:50am ACTIVITY #: 132801-01 DEADLINE TO REGISTER: June 10, 2016 AGES: 6 7 DATES: July 11 July 14, 2016 (M-TH) TIME: 11:00am 11:50am ACTIVITY #: 132801-02 DEADLINE TO REGISTER: July 1, 2016 AGES: 6 7 DATES: August 8 August 11, 2016 (M-TH) TIME: 11:00am 11:50am ACTIVITY #: 132801-03 DEADLINE TO REGISTER: July 29, 2016 YOUTH TENNIS Ages 8 and older are required to bring their own racquet. No Age Waivers Accepted. AGES: 8 11 DATES: June 20 June 30, 2016 (M-TH 2wks) TIME: 9:00am 9:50am ACTIVITY #: 132802-01 DEADLINE TO REGISTER: June 10, 2016 AGES: 8 11 DATES: June 20 June 30, 2016 (M-TH 2wks) TIME: 10:00am 10:50am ACTIVITY #: 132802-02 DEADLINE TO REGISTER: June 10, 2016
12 L E I S U R E C A M P S AGES: 8 11 DATES: July 11 July 21, 2016 (M-TH 2wks) TIME: 9:00am 9:50am ACTIVITY #: 132802-03 DEADLINE TO REGISTER: July 1, 2016 AGES: 8 11 DATES: July 11 July 21, 2016 (M-TH 2wks) TIME: 10:00am 10:50am ACTIVITY #: 132802-04 DEADLINE TO REGISTER: July 1, 2016 AGES: 8 11 DATES: August 8 August 18, 2016 (M-TH 2wks) TIME: 9:00am 9:50am ACTIVITY #: 132802-05 DEADLINE TO REGISTER: July 29, 2016 AGES: 8 11 DATES: August 8 August 18, 2016 (M-TH 2wks) TIME: 10:00am 10:50am ACTIVITY #: 132802-06 DEADLINE TO REGISTER: July 29, 2016 TEEN TENNIS Ages 8 and older are required to bring their own racquet. No Age Waivers Accepted AGES: 12 17 DATES: June 20 June 30, 2016 (M-TH 2wks) TIME: 8:00am 8:50am ACTIVITY #: 132803-01 DEADLINE TO REGISTER: June 10, 2016 AGES: 12 17 DATES: July 11 July 21, 2016 (M-TH 2 wks) TIME: 8:00am 8:50am ACTIVITY #: 132803-02 DEADLINE TO REGISTER: July 1, 2016 AGES: 12 17 DATES: August 8 August 18, 2016 (M-TH 2wks) TIME: 8:00am 8:50am ACTIVITY #: 132803-03 DEADLINE TO REGISTER: July 29, 2016
S P O R T S C A M P S C A L E N DA R 13 J U N E S M T W TH F S 1 2 3 4 5 6 7 8 9 10 11 June 20-23: FIELD HOCKEY, COED SOCCER, TRACK & FIELD June 27-30: COED SOCCER, BASEBALL June 27-July 15: CROSS COUNTRY June 28-July 1: PHYSICAL EDUCATION GAMES 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 J U L Y S M T W TH F S 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July 5-8: LACROSSE July 11-14: GIRLS SOCCER July 11-15: BOYS BASKETBALL July 12-14: VOLLEYBALL July 12-15: YOUTH FOOTBALL July 18-21: ELEMENTARY INTRO TO FOOTBALL FUNDAMENTALS, COED BASKETBALL July 18-22: BOYS & GIRLS BASKETBALL July 19-21: QUARTERBACKS & WIDE RECEIVERS July 25-28: BASEBALL July 25-27: ADVANCED COUGAR FOOTBALL July 25-28: WRESTLING July 26-29: ADVANCED CHARGER FOOTBALL A U G U S T S M T W TH F S 1 2 3 4 5 6 August 1-4: SOFTBALL August 1-5: SPORTS & MOTOR SKILLS 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
14 L E I S U R E C A M P S C A L E N DA R J U N E S M T W TH F S 1 2 3 4 June 20-23: MUNCHKIN TENNIS June 20-30: YOUTH TENNIS, TEEN TENNIS June 23-July 19: MUSIC 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 J U L Y S M T W TH F S 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 July 5-8: ENGINEERING FOR KIDS July 11-14: MUNCHKIN TENNIS July 11-15: HORSEBACK RIDING July 11-21: YOUTH TENNIS, TEEN TENNIS July 14-15: 7 HABITS OF SUCCESSFUL TEENS July 18-22: FRESHWATER FISHING 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 A U G U S T S M T W TH F S 1 2 3 4 5 6 7 8 9 10 11 12 13 August 1-5: ENGINEERING FOR KIDS August 8-11: MUNCHKIN TENNIS August 8-12: ENGINEERING FOR KIDS August 8-12: CHEERLEADING 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
SPOTSYLVANIA PARKS & RECREATION DEPARTMENT P.O. Box 28, Spotsylvania, VA 22553 (540)507-PLAY (7529) Camp Registration Form Please Print Legible One form must be filled out for each participant and for individual classes. First MI Last Boy Girl Complete Address City Zip Email Address Primary Phone Secondary Phone Is this a new address or phone number? Age (where applicable) Birth date Birth Certificate is (circle one) on file enclosed (a birth certificate must accompany this form if one is not already on file.) Shirt Size (circle): Youth Small (6-8) Youth Medium (10-12) Youth Large (14-16) (if applicable) Adult Small (34-36) Adult Medium (38-40) Adult Large (42-44) Adult XL (46-48) Medical Conditions, injuries, or allergies Emergency Contact Phone Camp/Activity Name Camp/Activity Date(s) Activity Number Fee: $ (Add $10.00 if registering after the stated deadline.) ($50.00 Fee on all returned checks) 2.95% NON-REFUNDABLE CONVENIENCE FEE CHARGED ON ALL CREDIT/DEBIT CARD TRANSACTIONS. Release of Claims: (Parent or Guardian must sign for those under age 18): I, the undersigned, do agree to indemnify and hold harmless Spotsylvania County, and the officers, employees, and the agents thereof, and Spotsylvania County School authorities, from any and all claims or liability, including attorney s fees and costs for any personal injury or other damage suffered as a result of participating in a camp/program. I understand that if I withdraw from the camp/program, I must do so by contacting the Spotsylvania Parks and Recreation Department by the registration deadline date stated on the front page of this form. I must follow up my verbal cancellation request with a written refund request. A 20% administrative fee will be charged on all refunds. I understand that if I withdraw from the program for any reason after the registration deadline, no refund will be available. Failure to attend a camp/program does not constitute a proper withdrawal, and the participant will not receive a refund. Parent/Guardian Signature Date: Print Name Checks Payable to Treasurer, Spotsylvania County. ($50.00 Fee On All Returned Checks)