School's Out CAMP NOMAD

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Join us for CAMP NOMAD! We keep the kids entertained and busy with all sorts of fun activities like kids karate, yoga, swimming (with instruction time), arts and crafts, outdoor sports AND MORE! This year we have added before/aftercare and a bus pick-up option for your convenience. Please submit one form per child.

Email *

Schedule & Pricing

How did you hear about Study Buddies AFTER SCHOOL @ NOMAD? *

Next Door

School FB Posting

NOMAD FB Posting

Shared on FB by someone

Drive-By/Walk-In

Web Search

Received from a friend

Sibling Enrolled

Attended Past Camps/Programs

None of the Above

Child's Gender *

Male

Female

FIRST NAME (Child) *

LAST NAME (Child) *

Child's date of birth *

YYYY

Grade & School Attending *

Choose your Days (complete each row) *

AM HALF DAY 8:30a-1:00p

PM HALF DAY 12:00p-4:30p

FULL DAY 8:30a-4:30p

EARLY 7:30a Drop-Off $10

LATE 5:30p Pick-Up $10

BOTH 7:30a & 5:30p $15

JAN 18 WED

FEB 15 MON

APR 2 FRI

APR 5 MON

APR 6 TUE

APR 7 WED

APR 8 THU

APR 9 FRI

BUS TRANSPORTATION AVAILABLE: Are you interested in pick-up between 7a-8a ($12 per day or $50 "bus pass" through Feb/Presidents' Day) from:

Blythe ES

Bonnie Cone

Cox Mill ES

Harris MS

Highland Creek ES

Lake Norman Charter ES

Lake Norman Charter MS

Odell Primary (Moss Creek)

Odell ES

Maybe

Other:

Clear selection

Parent/Guardian First and Last Name *

Parent/Guardian Street Address *

Parent/Guardian Contact Phone Number(s) *

Additional Parent email (optional)

Emergency Contact First and Last Name *

Emergency Contact Contact Number *

Emergency Contact Relationship to Camper *

Please list those people in addition to Parent/Guardian that are permitted to pick up your camper and their phone number and email address:

Please tell us a little about your campers swim experience and ability level. *

Medical Information: Name of Insurance Provider & Policy Number *

Medical Information: Primary Physician *

Please list ANY allergies that your camper has to any food, medications or environmental factors.

Please list and describe any health issues, medical conditions and/or physical concerns, as well as, any current medications.

Please list anything else you would like us to know about your child.

Terms of Agreement: NOMAD Aquatics & Fitness and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness with accompanying physician's note. Children's photos and quotes may be used for publicity purposes, In case of an emergency, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or physician). Please initial below. *

Photo Release: I hereby give permission for my child to be photographed at NOMAD Aquatics & Fitness. I understand the photos will be used for promotional purposes. I understand that although my child's photograph may be used for advertising, his or her identity will not be disclosed. I do not expect compensation and that all photos are property of NOMAD Aquatics & Fitness and its affiliates. Please initial below. *

Guardian Signature *

$25 Registration Due - covers 1 year of programs (camps & lessons) *

Waived - paid $25 registration for swim lessons within 1 year

Waived - if a current member of Study Buddies

Waived - if a current/active member of Evolution Swim Team

$25 non-refundable, due at registration

SPECIAL! Waived-if registering before 11/20/20

Waived - if a current member of After School

$20 Deposit Due - for each day selected *

I understand that $20 x the number of days selected is due as a deposit at registration and is not refundable without a doctor's note or a change in COVID restrictions.

Payment Options: *

None

Registration Fee and/or Deposit (at Registration)

Balance Due for Camp (2 days prior to start)

Credit Card + 3% Convenience Fee

ACH Draft

Check (must be received by 2 days prior to camp start or it will be auto-drafted by method of payment provided)

Enter Method of Payment (ACH - Bank Name, Routing, and Account number OR CC info with date of expiration and CVV code). If entered for another child, please type "provided". *

I authorize NOMAD Aquatics & Fitness to draft my CC or make an ACH DRAFT for a registration fee (if due) and camp deposit ($20 per day) that is not refundable. The balance will be due 2 days prior to camp start and will be automatically drafted by the method selected above if a check is not presented before that time.

Printed Name of Parent/Guardian *

Date Submitted *

YYYY

A copy of your responses will be emailed to the address you provided.

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