Fall Camps 2022 - Mindful Sports

Parent Name*

First Last

Child Name*

First Last

Child's DOB*

Email Address*

Phone*

Allergies/Special Needs/Notes

If Adding a Second Child (Name, DOB)

If you would like to add a sibling(s) registration, please do so here, along with their DOB and week(s) attending. We will contact you for additional payment, with all sibling discounts for all children, at a later date.

Authorized Adults*

Please list all authorized adults for pick up

Remaining DOE Holiday Camps

Thursday, November 3rd (Half-Day Camp -PS130 ONLY)
Tuesday, November 8th (SOLD OUT)
Friday, November 11th (SOLD OUT)
Thursday, November 17th (Luria Camp)
Friday, November 18th (Half-Day Camp -PS321 ONLY)

Luria November Holiday Camp Date

Price: $160.00

Put "1" in the quantity field

DOE Holiday Camp Dates

Price: $160.00

Put the number of DOE Holiday Camp dates you registered for in the Quantity Field

DOE Holiday Camp Dates (Fall Families on Same Weekday ONLY)

Price: $50.00

If you are registered for a PICK UP weekday in the Fall After-School Program that you are choosing the SAME weekday DOE Holiday Camp date, select this option. If you are registered for 2+ pick up weekdays/week in the Fall Program, or have siblings in the pick up program, your fees are waived for DOE camp dates on THAT/THOSE weekday(s) and no payment is needed. If you are registering for a camp date that is NOT on your weekday(s) in the Fall Program, please select the full DOE camp price above.

DOE Holiday Camp Dates (Fall Families on Same Weekday ONLY)

Price: $80.00

If you are registered for a DROP OFF weekday in the Fall After-School Program that you are choosing the SAME weekday DOE Holiday Camp date, select this option. If you are registered for 3+ drop off weekdays/week in the Fall Program, or have siblings in the pick up program, your fees are waived for DOE camp dates on THAT/THOSE weekday(s) and no payment is needed. If you are registering for a camp date that is NOT on your weekday(s) in the Fall Program, please select the full DOE camp price above.

Total

$0.00

COVID Vaccine Card Upload

Max. file size: 300 MB.

If you haven't sent us your child's vaccine card in previous seasons, please do so here

Consent*

I agree to the waiver of liability

I, the parent/guardian registering my child[ren] for a Mindful Sports program, am aware that participation in youth sports programs has some inherent risks and injury can occur. On rare occasions these injuries can be serious. In consideration of my child[ren] being allowed to participate in Mindful Sports programs, I, the parent/guardian, assume the risk of participation and agree not to hold Mindful Sports, the program directors, coaches, assistant coaches, or owner responsible for any and all injuries caused by or resulting from participating in Mindful Sports Programs. I understand that this program is taking place during a time when Coronavirus presents additional risk. I understand these risks. In the event of any injury or illness caused directly or indirectly by Coronavirus or any such virus, I will not hold Mindful Sports, and all associated parties previously mentioned, responsible. By selecting the "I agree" button above, I state that I understand this description and agree.

Consent

I agree to the permission for photographic likeness

I, the parent/guardian registering my child[ren] for a Mindful Sports program, authorize the use of pictures of the above-named child participant to be posted on the Mindful Sports website or advertising media published by Mindful Sports

Credit Card

Card Details

Cardholder Name

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Fall Camp 2022 Form