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Maine Golf & Tennis Academy

CHECKLIST OF DEADLINES The Deadline for All Paperwork is May 1st unless otherwise indicated. Please make sure you have included each of the following Forms in your Application Packet and mail to:

Maine Golf & Tennis Academy 35 Golf Academy Dr. Belgrade, Maine 04917 1-800-465-3226

FORM DATE SENT IN (Give Date) Application for Enrollment IMMEDIATELY Terms of Agreement IMMEDIATELY CAMPER'S AGREEMENT FORM

June 1st

Personal Information Sheet May 1st Personality Type Test

May 1st

Medical Information/Physical Form

June 1st

Transportation Form: Arrivals May 1st Transportation Form: Departures

May 1st

Trips/Program Permission Slip May 1st Equipment Rental/Requests

May 1st

GOLF and/or TENNIS Level Determination May 1st Camper Customized Curriculum Form

May 1st

NIKE Uniform Order

May 1st

Packing List With Luggagae PAYMENT SCHEDULE

Mini Session

Full Session

Family Camp

Deposit With Application 2nd Payment December 15th 3rd Payment March 1st Final Payment April 30th

$2,000.00 $1,000.00 $1,000.00 ALL FEES

$2,000.00 $2,000.00 $2,000.00 ALL FEES

$2,000.00 $1,000.00 $1,000.00 ALL FEES

All Fees Include a NON REFUNDABLE Administrative Fee, NO REFUNDS after April 30th

Thank You


APPLICATION FOR ENROLLMENT 2012

Maine Golf & Tennis Academy

PACKING LIST

Maine Golf & Tennis Academy

Please indicate the numbers of each item packed for your son or daughter in the first space provided and send this completed form to the Camp Office so we can help insure return of all items packed.

35 Golf Academy Drive Belgrade, Maine 04917 1-800 GOLF CAMP/207-465-3226 Fax 207-465-2822 www.tenniscamp.org www.golfcamp.com

All items are REQUIRED unless otherwise specified as OPTIONAL

Camper’s Name: _________________________ Age: _____ Session Attending: ________ Clothing (Per 2 Weeks)

Camper Name:

Equipment

Pants/Jeans - 3 pair Flannel/Wool Long sleeve shirt - 1 Under garments - 8 pair T-shirts, plain - 3 Sweater/sweatshirt - 1 Bathing suit (girls: one piece only) - 2 Socks, wool & cotton - 8 Sneakers - 1 pair Pajamas - 2 Shorts - 3

Twin size Sheet Set (2) & Blanket Insect repellent (not spray) Pillow Flashlight Backpack Rain Gear - raincoat/poncho: REQUIRED!! Sun screen Laundry Bags - 2 LABELED!! Sleeping Bag (if going camping - Optional) Hiking boots (if going camping- Optional)

GOLF Equipment/Uniform

TENNIS Equipment/Uniform

Sunday Golf Bag, Clubs & golf towel Tennis Racquet Soft Spike golf shoes & sturdy sneakers Tennis Shoes for Clay Courts Golf Balls - 2 dozen 1 work out suit - pants and jacket Golf gloves - 2 4 pair white or navy tennis shorts 4 pair Navy Golf shorts 5 MTA Emblem T- shirts - thru MGTA Long Pants Navy 1-2 pair 2 MTA Emblem Polos - thru MGTA ________6 MGTA Emblem Polos- thru MGTA MTA Emblem Windshirt - thru MGTA MGTA Emblem Windshirt - thru MGTA MGTA Emblem Cap - thru MGTA MGTA Emblem Cap - thru MGTA MGTA Water bottle - thru MGTA MGTA Water bottle - thru MGTA * Golf/Tennis Combination Program - Purchase 5 Polos, 4 T-Shirts, 1 Jacket, and 1 Cap NO Gum or Candy NO Electronic Games

NO PDA's, DVD Players

NO Personal Vehicles

NO Fireworks NO Weapons NO Hunting Knife NO Expensive Jewelry

SHIP ALL BAGGAGE AND GOLF CLUBS BY FEDERAL EXPRESS or UPS

This is especially important for campers arriving by plane - campers arriving by car may bring all luggage with them. Bags must arrive 5 days before your child’s scheduled Session and we will ship bags home COD within 2 days after their departure. Please provide a Fed Ex Account Number or Credit Card Information for Charges. Federal Express Account #__________________________ Credit Card # _____________________________________

We will try our hardest to get everything your child brought to camp back home; however, we CAN‘T GUARANTEE it will all make it home. Please help us by labeling EVERYTHING and Getting a copy of this Packing List to the Office BEFORE your child’s arrival!

LABEL ALL CLOTHING & EQUIPMENT WITH CHILD’S FULL NAME!!!! © January 27, 2012 This form is accurate at the date of printing. The website www.golfcamp.com always has the most up to date and official dates, fees and information.

Gender M or F Nickname ___________ Shirt Size: ____ Birthdate: / /

Nickname:

Camper e-mail: Age: 06/30/12 Grade: 09/01/12

Home #( Fax #( Cell Bus

) )

#( ) #( )

#( #(

) )

Billing/Other Address: Emergency Contact: Relation: Phone #( )

****PROGRAMS, DATES & FEES FULL SEASON 06/24 - 08/17

$9,500.00

SESSION 1 June 24th - July 20 $6,400.00

(Please Circle All That Apply)

BIG SESSION HALF SESSION 1A HALF SESSION 1B

SESSION 2 July 22nd - August 17th $5,800.00 HALF SESSION 2A HALF SESSION 2B

****

06/24-08/03

$8,500.00

June 24th - July 6th July 8th - July 20th

$3,995.00 $3,995.00

July 22nd - August 3rd August 5th - August 17th

$3,800.00 $3,500.00

CIT (Director Invitation Only: Session 1 or 2 only. Going into 11th grade Discount > see www.golfcamp.com) FAMILY CAMP August 19th - August 24th $2,995.00/2 People $600.00 each additional #Attending Arrive 2pm, Depart 11am OVER 50'S August 19th - August 24th $4,995.00/4 People 4 per Cabin #Attending Arrive 2pm, Depart 11am Half-Session Session 1 or 2 Big Session Full Season ADVANCED GOLF: $ 395.00 $ 695.00 $ 995.00 $ 1,295.00 ELITE TENNIS : $ 800.00 $1,500.00 $ 2,100.00 $ 2,800.00 *All Prices Subject to Change > See Website for most current & correct pricing - www.golfcamp.com

PROGRAM (Please Circle):

Golf Family

Tennis Lite Serve & Turf (Golf/Tennis) KID at HEART (Over 50’s) CIT

** SEE WEBSITE for ENROLLMENT DISCOUNTS golfcamp.com **

NO Hair Dryer NO Cell Phones

NO Pets/Animals NO Food

Last Name

Father's Name: Cell Employer: Bus E-mail:

DO NOT BRING ANYTHING VALUABLE - Nothing you want Lost or Stolen! NO Drugs, Alcohol, Cigarettes NO Television or Computer

Address: School: Mother’s Name: Employer: E-mail:

Toiletries Other Good Things to Have - OPTIONAL Toothbrush Sandals/Tevas ­ Toothpaste Letter writing/Postcards stamped Soap Bathrobe Shampoo/conditioner Camera & Film Face Cloth Disposable Camera Comb/brush Book(s), Journal Towels - 3 Musical Instrument Other personal needs (Feminine needs -Pads are allowed, tampons are NOT!)

Please send a Digital Camper Head Shot to fun@golfcamp. com

****PAYMENT INFORMATION**** Enclosed Is My Deposit For: $

Minimum Due with Application:

$2,000.00

Paid By (Please Check) NOTE: A 3% additional charge will be applied to ALL Credit Card Payments Check: Payable to Maine Golf & Tennis Academy, 35 Golf Academy Drive, Belgrade, ME 04917

Credit Card:

(Circle)

MC VISA AMX DISC (My signature approves charges on all Payment schedule dates)

#

ID # Exp. Date:

Name on Card: Signature: Wire Transfer: In US Dollars to Kennebec Boys Camp, Inc. dba Maine Golf Academy Beneficiary Bank of America 33 Main Street, Waterville, Maine 04901 USA

Phone # (207) 877-2390 SWIFT CODE: BOFAUS3N Account # 458001259923 ABA Routing # 0260-0959-3

Please Make & Keep A Copy for Yourself and Return this Form as soon as Possible


Maine Golf & Tennis Academy

TERMS OF AGREEMENT: __________________ FEES INCLUDE

Tuition Includes: greens fees, meals, room & board, medical first aid attention (not including medicine, prescriptions, doctor or hospital visits, medical treatment, operations or procedures, x-rays, or anything that can not be handled by our nurse on duty), and trips such as lobster feasts, mountain hiking, rock climbing, whale watching and planned camp activities (if enrolled by April 30th). Fees are based on the number of weeks of attendance and the date we receive your deposit. In order to reserve space for your camper and qualify for any enrollment discounts we must receive a deposit of $2,000.00 per camper along with this Application and payments must be received by the scheduled dates below. Late payments nullify all discounts. All fees must be paid in full before campers will be permitted to attend camp.

PAYMENT SCHEDULE Deposit With Application 2nd Payment by Dec. 15th 3rd Payment by March 1st Final Payment by April 30th

$ 2,000.00 All and final payments are due on PAYMENT PLANS AVAILABLE $ 2,000.00 April 30th. All fees not paid by April Please call for details $ 2,000.00 30th incur a $250.00 late charge. ALL FEES DUES

ADDITIONAL FEES REQUIRED: Included in Tuition Price: Transportation to/from Portland International Airport during designated times, dates, and locations ESL Lessons are Included in the price of Tuition ________Uniforms: $300.00 for Golf &/or Tennis $350.00/Serve & Turf ________Camper Account: $150.00/Half Session $300.00/Session $400.00/Big Session $500.00 Full Season OPTIONAL: Transportation must be arranged on the TRANSPORTATION Arrival/Departure Forms. Transportation outside designated times, dates, and/or locations CAN ONLY be arranged on our MGTA TRANSPORTATION FORMS by the parents and will incur an extra charge based on time, date and place. All US campers must ship Luggage to and from Camp! Boston Airport Transportation: $175.00 each way. Connecticut Van/Bus: $200.00 each way. Offered for Session 1 and/or 2 Dates of Arrival and Departure ONLY! White water Rafting: $125.00 The trip is offered one time during each Session Club Rental $100.00/Half Session $150.00/Full Session $200.00/Big Session $225.00/Full Season Linens $100.00/Half Session $150.00/Full Session $175.00/Big Session $200.00/Full Season Includes blankets, sheets, pillow, pillow case (sleeping bags and towels not included)

GENERAL INFORMATION All campers must have adequate medical insurance to cover all medical expenses incurred while at camp. Proof of Medical Insurance and a Physical Exam are required annually. Maine Golf & Tennis Academy, its owners and directors, reserve the right to dismiss for cause any camper whose conduct or influence is unlawful, in violation of camp policy, or is deemed unsatisfactory to the camp community. In such event there will be no reduction or refund of camp fees. Maine Golf & Tennis Academy, its owners and directors, reserve the right to use any individual or group photographs, video, digital, and/or audio recordings taken at Camp and elsewhere documenting campers in activities for camp publicity and public relations purposes, including publication on the MGTA web site, both now and in the future.

REFUND POLICY: All Fees Include a NON REFUNDABLE Administrative Fee Withdrawal or change in arrangements of any kind must be submitted in writing and received before April 30th. Refunds for payments made will be issued in full, less the $600 Administrative Fee if the request is received in writing before January 1st. Refunds for payments made will be issued in full, less the $1,000 Administrative Fee, if the request is received in writing before April 30th. No refunds, reductions, allowances, or credits against fees paid or due will be made after April 30th for any reason, including cancellation, late arrival, early withdrawal, or dismissal of camper. Any and all Refunds will be issued on or about April 30th. Campers that convert from one length session to another will pay fees quoted at the time of the change and forfeit all early enrollment discounts. The undersigned agrees not to charge back any amount on any and all credit card payments. Cancellation Insurance is available through www.mycampprotector.com.

PERMISSION STATEMENT I give permission for my child to participate in all in- and out-of-camp sponsored activities including but not limited to: waterskiing, white water rafting, sailing, rock climbing, ropes course, sports, waterfront activities, trips, golf, tennis, and travel in vehicles. I understand these activities might have risks and dangers connected with them; however, I release Kennebec Boys Camp, Inc., dba Maine Golf & Tennis Academy, its Directors, and all its agents and staff from any legal actions or claims that my child, I, or the legal guardian might have for the damage or injury to the child named above or any personal property arising from being a camper at or participating in any activity in the Maine Golf & Tennis Academy Program(s). This agreement, and any disputes or claims against the Directors, employees, agents or the Kennebec Boys Camp, Inc. dba Maine Golf & Tennis Academy, shall be interpreted, governed and constrained by laws and courts of The State of Maine and all legal actions shall be under the jurisdiction of The State of Maine.

NO REFUNDS of any kind will be given after April 30th In Agreement With All Terms As Outlined on Both Sides of This Form: Signature of Parent:

CAMPER's AGREEMENT FORM

(Camper's Name)

Date:

How did you hear about the Maine Golf Academy? Please send information about the Maine Golf Academy to our friends listed below: Camper Name Camper Name Address Address Phone # Phone # e-mail e-mail

MGTA POLICIES & CODE OF CONDUCT

Dear MGTA Family: Due to the multi-cultural nature of our community and the variety of value systems and expectations of behavior with which our campers arive at our doorstep we feel it necessary to clearly state our Code of Conduct and express the seriousness with which we require its adherence by each member of our MGTA Family. The following codes are enforced to ensure a safe, successful and enjoyable summer for all: • Treat Others As You Wish To Be Treated NO ONE is allowed to have fun at the expense of another. We WILL NOT tolerated disrespectful and/or inappropriate behavior to peers or staff. Bullying, teasing, and any other form of verbal or physical assault may result in dismissal from camp.

• Always Leave your Campsite in a Better Condition Than You Found It Defacing camp property will not be tolerated. Any camper causing any damage to camp property will be billed for damages and may be asked to leave camp.

• Safety First All potentially dangerous items - knives (Swiss Army, boy scout, etc.), lighters, laser pointers, heating coils, aerosal cans, scissors, fireworks, etc. are strictly prohibited. Such items will be confiscated and the campers may be sent home.

• Alcohol, Drug and Smoke Free MGTA strictly prohibits the possession or use of alcohol, illegal drus and cigarettes. Staff or campers involoved in any incidents involoving these substances will be removed from camp immediately at the camp's sole discretion.

Campers will be reminded of these Policies and their agreement to follow them upon their arrival during Camper Orientation. We are committed to maintaining the safest, healthiest, and happiest experience possible for each and every camper. We know our campers want the same and expect each one to observe all our policies during the summer. Pleae read thefollowing policies below as well as the Internet Policies on the following pages and review each carefully with your children prior to camp. Make sure that you clearly describe and discuss these guidelines and these consequences for not following each for your child. Thank you and we look forward to a great, happy, healthy and safe Summer! Yours, Joel & Crista Lavenson Owner/Directors


CAMPER's

Maine Golf & Tennis Academy

Maine Golf & Tennis Academy AGREEMENT FORM: MGTA POLICIES & CODE OF CONDUCT

CAMPER's AGREEMENT FORM MGTA INTERNET POLICIES

Please Print neatly Camper’s Name: ____________________________________________________

POLICY

DISIPLINARY ACTION

Campers are not permitted to possess and/or consume in any manner, or be in the presence of someone using or possessing, illegal drugs and/or prescriptive medicines or drugs unless prescribed by a physician and registered immediately upon arrival with the Infirmary. Campers are not permitted to possess or consume or be in the presence of someone possessing or consuming, alcoholic beverages of any type. Smoking by campers is strictly prohibited (cigarettes, cigars, pipes) anywhere. No camper shall act in a violent or aggressive manner, or cause physical assault, or cause to threaten such behavior. No camper shall tease, bully, or pick on another camper Campers are required to attend all activities except when excused by a Director or excused for reasons of health by the Infirmary

Immediate dismissal from camp

Willful damage to camp property and equipment is a serious offense. All campers are expected to treat all property and equipment with the care and respect accorded to their own personal property. Defacing camp property in any way will not be tolerated. Any graffiti including writing, drawing, carving, or painting names or pictures on furniture, cabins, or building walls are all examples of this and will be considered a serious offense Theft of camp’s or other person’s property, however small is a serious offense No camper is permitted to possess or use fire, candles, mosquito coils or fireworks of any kind No camper is permitted to possess a knife or any kind of other sharp or dangerous tool or weapon, real or fake No camper is permitted to tamper with any safety devices including fire alarms, and fire extinguishers No campers shall bring to camp a cellular phone or use the camp phone without permission of a Camp Director

Dear Parents, With more and more children using the Internet, cell phones and other technologies at younger ages, we appeal to you as parents to partner with us to ensure that your children continue to have the safest, most wholesome experience with us at camp as possible. Below we have outlined the challenges some technologies pose to the continued health and safety of our camp community. Please review with your child the enclosed policies regarding the Internet, social networking sites and exchanging contact information with their counselors. As always we invite you to call us if you have any questions or concerns about any of these issues.

Cell Phones Immediate dismissal from camp

Loss of privileges and parental involvement Loss of privileges, possible cabin change, parental involvement, possible dismissal First time -Discussion with camper and guidance Second time – Discipline and loss of privileges Third time – Parental involvement Loss of privileges, maintenance work, and parents held responsible for cost of repair or replacement

 

Loss of privileges, maintenance work, and parents held responsible for cost and repair or replacement

 

Loss of privileges and parents advised, restitution to be made. Confiscation, parental involvement Confiscation, parental involvement Loss of privileges and parental involvement Confiscation of cellular phone and parental involvement

Please sign below to confirm that you have read and understand both sides of this page and agree to follow each of these policies.

Signatures are required for attendance! Camper Signature

____________________________________

Date ___________________

Parent Signature

____________________________________

Date ___________________

As you know we have a “no-cell phone” policy at camp. Aside from the fact that cell phones are expensive and can get lost or stolen and that the physical camp environment is not kind to such items, there is a fundamental problem with campers having cell phones at camp, and that is trust. When children come to camp they—and you—are making a leap of faith, temporarily transferring their primary care from you as their parents to us and their counselors. This is one of the growth-producing, yet challenging aspects of camp. As children learn to trust other caring adults, they grow and learn, little by little, to solve some of their own challenges. We believe this emerging independence is one of the greatest benefits of camp. It is one important way your child develops greater resilience. Contacting you by phone essentially means they have not made this transition. It prevents us from getting to problems that may arise and addressing them quickly. Sending a cell phone to camp is like saying to your child that you as the parent haven’t truly come to peace with the notion of them being away from you and in our care. We agree to tell you if your child is experiencing a challenge in their adjustment to camp. You can help by talking with you child before they leave for camp and telling them that there is always someone they can reach out to, whether it be their counselor, a trusted activity leader, the Head Counselor, the Director or camp nurse or health care provider. We are all here to help, but if you don’t trust us, your children certainly won’t!

Digital Photographs Another drawback of having cell phones at camp is many of them have built-in cameras. It has happened at some camps around the country that children have secretly taken photographs of other campers or staff during changing or showering times and later uploaded those images onto the Internet. (If you belong to a health club, chances are it has “no cell phone” policy). To lessen the possibility of this happening we have decided to ban all digital cameras and suggest that if your child wants pictures from camp, that they bring a disposable film camera. We take photographs during the summer, which are available for viewing on our secure (password required) website. Please help us maintain a safe environment by explaining this to your child (see our accompanying note on “Policies for Campers.”) You should know that any camper that takes a compromising photograph of another camper or staff member and uploads it on the Internet or makes it public in any way may be subject to dismissal from camp or may not be allowed to return. If the law is broken, the appropriate authorities will be notified.

Cyber-Bullying and Harassment It has happened at camps around the country that a few campers have sent rude, demeaning, intimidating or vulgar e-mails or IMs to other campers or have created false screen names to harass members of the camp community or spread false and damaging information about them. To be sure most Internet communication is fun, positive and one important way campers stay in touch with their friends. Our “Policy for Campers,” which we are asking you to read over and then read with your child, covers our response to this problem. In addition, we have outlined the steps you or your child should take should they receive an abusive, demeaning or otherwise threatening or inappropriate Internet communication. Being familiar with these steps is part of the overall safety and healthy practice you should have in place with your child if they are online, regardless of whether they attend camp or not. Sharing them with you is one way we felt we could support your effort to protect your children whether they are at camp or not.

Your Kids, Our Staff after Camp Our pledge is to put your children in the company of the most trustworthy and capable young adults we can hire—counselors who are well suited to the task of caring for campers. The effort we put into screening and selecting our staff is part of that pledge. Our staff work with your children in the context of a visible, well scrutinized environment that has many built-in checks and balances. Counselors are supervised by senior staff guided by clear, firm policies regarding behavior. Their actions are also visible to co-workers and campers. By hiring them we do not recommend them as baby-sitters, Nannies or child companions outside of camp. In general we discourage our staff from having contact with your children after camp since we cannot supervise it. We hire our staff for the camp season. We do not take responsibility for their behavior off-season. As a parent you are, of course, free to make your own choice in this matter. While we cannot keep you from allowing your child to visit with one of our staff members, in so doing you take full responsibility. We also know that many children exchange contact information (e.g., e-mail address, profile names, cell phone numbers) with counselors without our or your specific awareness or permission.


CAMPER's

Maine Golf & Tennis Academy AGREEMENT FORM: MGTA INTERNET POLICIES (2)

Maine Golf & Tennis Academy

PERSONAL INFORMATION FORM

We recommend that you as the parent supervise your child’s online activities just as you do other aspects of their life in your home, and oversee any off-season contact our staff members and your child. You take full responsibility to oversee any contact that results.

Working Together to Keep Your Children Safe We see many positive, exciting ways for youngsters to enjoy the healthy benefits of the Internet and other technologies. As advocates for children we want to work with you to keep those experiences safe, healthy and positive. That is why we have taken the time to write these policies, include some resources for you and urge you to talk with your children—both about camp and their online activity in general.

Camp Policy for Campers and the Internet

• We view e-mail, IM and social networking sites, like Facebook.com and MySpace.com, as positive ways for you to express

yourself and keep in touch with your friends. As a camper you have the right to exchange e-mails orIMs with other campers and invite other campers to be on your “friends” list in any way that you and your parents see fit.

• When it comes to exchanging contact with anyone on our staff, however, your parents must take full responsibility for you to do that. This includes giving or getting an e-mail or IM address, cell phone numbers, social networking profiles, weblogs or any other Internet contacts. (We tell this to the staff during orientation). We know your relationships with your counselors are important; however, once they leave camp, we can’t take responsibility for what happens between you and them— only your parents can. You and your parents must sign this form before a counselor can give you any contact information or take any contact information from you.

• Regarding e-mails, IMs and comments you may make to other campers on their social networking site, you must: a) keep what you say positive and respectful of staff and campers alike; b) do not use obscenities, vulgar or sexual language; c) do not say mean or threatening things to or about other campers or staff; d) do not post pictures online that would embarrass or violate anyone’s privacy; e) do not pose as another camper online or spread false information about anyone or say damaging or threatening things to or about anyone; f) do not use a website, blog or e-mail to talk about things that are against camp policy, (i.e. drugs, alcohol, bullying, sex)

• Most Internet communication is positive, and that’s great! In the rare case where there might be any negative messages to other campers or staff, our policy is to call the parents of campers who send those messages and share the content with them.

The answers to the following questions will assist us in providing the best quality staffing and services for your son and/or daughter. Please complete this Form and return it with the rest of your Application Packet by May 1st. Thank you. Camper Name: ____________________________________________________________________ Please List Any Bunk Requests Here: ___________________________________________________

1

What do you hope your child will learn or gain from his or her experience at The Maine Golf & Tennis Academy? In other words, what part does golf, tennis and/or hockey play in your child’s life now, and what do you hope this camp experience will do for that relationship?

2

How does you child learn most effectively? Auditorily, Visually, through Experience, or through Written Instruction? Please Explain.

3

Do you anticipate any activities with which your child might face difficulty while at camp? If so, please explain.

• We will use any legal means available, including contacting the police and the FBI, to track the source of any offending or threatening Internet communication if we need to. • Any camper who violates any of our policies regarding the Internet or other communication might have to leave camp, might not be able to come back to camp and might even have to answer to the police or other law enforcement authorities.

• We want you to be safe on the Internet. If you receive a threatening e-mail, IM or message on your personal website—one that is mocking, uses vulgar or harassing language—here is what you should do: a) Do not respond to the message or retaliate, because it might encourage the sender or get you into trouble. b) If possible, record the message onto your hard drive. c) Print out a copy of the message, then close it but do not delete it. d) Tell your parents about it and have them notify the local police aand/or, if necessary, contact your Internet service provider (yahoo, aol, earthlink, g-mail, etc.) e) If you suspect that the sender is from camp, call us immediately. f) You or your parents can also contact Pedowatch (www.pedowatch.com) or the National Center for Missing and Exploited Children (www.nemec.org). g) Camp is meant to be a fun, safe and happy place for all of us. We need your help to keep the way people from camp communicate with one another positive and in the spirit of camp—a way that makes everyone feel safe.

Please Print neatly Camper’s Name: ____________________________________________________

4

Does your child have any concerns of which we should be aware? For example, physical limitations, self esteem issues, learning disorder, attention deficit disorder, or any fears of going to camp? Is he or she receiving help in the described area (if appropriate)?

5

Is your child experiencing any changes at home that may make his or her camp experience more difficult (moving to a new home, divorce, death in the family, etc.)? If so, please identify and tell us how he or she is adapting to the changes.

Please sign below to confirm that you have read and understand both sides of this page and agree to follow each of these policies.

Signatures are required for attendance! Camper Signature Parent Signature

____________________________________ ____________________________________

Date ___________________ Date ___________________

Parent’s Signature: ____________________________________________

Date: _____________


Maine Golf & Tennis Academy

Maine Golf & Tennis Academy

MEDICAL INFORMATION FORM A

PERSONALITY TYPE TEST PERSONALITY TYPE ASSESSMENT:

___________________________ (Camper’s Name)

COMPLETE IN ENGLISH ONLY! Parent/Guardian and Family Doctor must complete & sign this Form! You must enclose a copy of Medical Insurance Card/Information, and Return to us by June 1st for Attendance! (A Physical Form signed by your doctor may be substituted for his signature on this form BUT we do need this form completed & returned along with it!)

In order to better understand how best to communicate with and teach your child we utilize a Personality Type tool based on the work of Katharine Briggs and Isabel Briggs Myers, creators of The Myers Briggs Type Indicator instrument® (MBTI)®. Below is a quick assessment of your child’s Personality Type. Have your child fill this assessment out completely and mail it to us with the completed forms as soon as possible. Review each word in the four sets of word pairs carefully. Choose the ONE word in each pair which most accurately describes the “real you” (rather than behavior which may be required of you in a particular setting, such as school). Place a check mark beside the ONE word in each pair that you choose. There are no right or wrong responses – we are all at least a little of each!

Camper Name:

Home Address:

Birth date: / / Phone Nbr: ( School:

Parent/Guardian:

Home Phone: ( Cell Phone: ( Bus. Phone: ( E-mail:

) ) )

Home Phone: ( Cell Phone: ( Bus. Phone: (

) ) )

Home Address: Employer: ­­ Business Address:

Second Parent/Guardian:

E

or

I

S

or

N

____ Lively

____ Calm

____ Concrete

____ Abstract

____ Talkative

____ Reserved

____ Builder

____ Inventor

____ Expressive

____ Quiet

____ Realistic

____ Idealistic

____ Interaction

____ Concentration

____ Practical

____ Ingenious

____ Outward

____ Inward

____ Literal

____ Figurative

____ Talk

____ Listen

____ Doing

____ Assessing

____ Outspoken

____ Introspective

____ Realities

____ Possibilities

____ TOTAL ____ TOTAL ____ TOTAL ____ TOTAL

T

or

F

J

or

P

____ Just

____ Humane

____ Scheduled

____ Spontaneous

____ Logical

____ Sentimental

____ Disciplined

____ Free Spirit

Home Address: Business Address:

Sex: _____ Age: ) Grade:

Emergency Contact: _________________________ H/B Phone: ( ) Medical Insurance Coverage: Insurance Company Policy #: Include Proof of Insurance(Copy) Phone:

Health History - Check those items that apply & Give Approximate Dates: Frequent Colds Menstruation started Constipation __Asthma Ser. Poison Ivy/Oak Hearing Impairment

Ear Infections Menstrual Problems Diabetes Hay Fever Frequ. Sore Throat Vision Impairment

Fainting Bronchitis Heart Trouble Sunstroke Tonsillitis Contact Lenses

Bed Wetting Upset Stomach Convulsion Headaches Sleeping Problems Other (Please list)

All US Campers needing Medications aqre required to use our pre-packaging medication service A $150.00 Fee Will be assessed for US Camper Medications Sent NOT Using CampMeds Register on line at CampMeds.com or call 1-954-577-0025 Camper Medications

Dosage

Reason(s) for Medication

____ Analyze

____ Empathize

____ Structure

____ Flow

____ Head

____ Heart

____ Plan

____ Improvise

Tetanus Immunization (Very Important!) Date of most recent shot: __________________________________ Other Information (Use Additional Paper to Provide Additional Information): Physical Limitation(s): Operations or serious injuries (Details): Allergic Reactions: Bee Stings: Penicillin:

____ Critique

____ Appreciate

____ Organized

____ Free Flowing

Other drugs, food, plants, or animals which cause reaction(s):

____ Firm-minded ____ Tender-hearted

____ Finish

____ Start

Doctor’s Name:

Phone: (

____ TOTAL

____ TOTAL

____ TOTAL

Signature:

Date:

____ Thinking ____ Feeling ____ Decide ____ Wait & See

____ TOTAL

Add up the total number of check marks in each column and write that number in the spaces marked TOTAL. Circle the Letter at the top of the column that received the most check marks Write each of the four letters you circled (E or 1, S or N, T or F, and J or P) below.

Results:

______ E or I

_______ S or N

______ T or F

______ J or P

See www.personalitytype.com for more information regarding your child's Personality Type.

**PERMISSION**

)

This Health History is correct as far as I know and the person herein described has permission to engage in all prescribed activities as noted. Emergency Authorization: I hereby give permission to the medical personnel selected by the Camp Director to order X-rays, routine tests, and treatment for me/the above named camper in the event I cannot be reached. I hereby give permission to the physician selected by the program director to hospitalize, secure proper treatment for and order injection(s), surgery and/ or medications for me/the above named camper. Further I authorize payment for such needs on my credit card: MC VISA DISC AMEX Card No: __________________________________ ID #___ ___ ___ Name on Card _____________ Exp Date: _____ Signature of Parent/Guardian:­­­­ Date: Signature of Witness: Date: I understand and will abide with all restrictions placed on my activities: Signature of Minor: Date: ___________


Maine Golf & Tennis Academy

Maine Golf & Tennis Academy

MEDICAL C - Camper Health History (1)

MEDICAL B - Healthcare Recommendations To Parent(s)/Guardian(s): Complete this section and give this form (FORM 2) and a copy of your completed CAMPER HEALTH HISTORY FORM (FORM 1) to your child’s health-care provider for review.

Developed and reviewed by: American Camp Association, American Academy of Pediatrics Council on School Health, & Association of Camp Nurses

Dates will attend camp: from ______________to_____________ Month/Day/Year

Month/Day/Year

Camper Name: _____________________________________________________________ First

Middle

Mail this form to the address below by June 1

Last

Age on arrival at camp ________

Month/Day/Year

First

" Male !" Female !!!Birth Date ____________

Camper home address: ________________________________________________________

35 Golf Academy Drive Belgrade, Maine 04917 FAX 207 465-2822

____________________________________________________________________________ City

State

Zip Code

Custodial parent(s)/guardian(s) phone: (_______)______________ (_______)____________ Parent(s)/guardian(s) stop here. Rest of form to be completed by medical personnel.

The following non-prescription medications are commonly stocked in camp Health Centers and are used on an as needed basis to manage illness and injury. Medical personnel: Cross out those items the camper should not be given.

Physical exam done today: " Yes " No

(If “No,” date of last physical: ___________) Month/Day/Year

ACA accreditation standards specify physical exam within last 24 months.

Weight: _______ lbs Allergies:

Height: _____ft_____in

Middle

Blood Pressure_______/_______

" No Known Allergies

" To foods (list): " To medications: (list): " To the environment (insect stings, hay fever, etc.– list): " Other allergies: (list): Describe previous reactions: Last

Acetaminophen (Tylenol) Ibuprofen (Advil, Motrin) Phenylephrine (Sudafed PE) Pseudoephedrine (Sudafed) Chlorpheneramine maleate Guaifenesin Dextromethorphan Diphenhydramine (Benadryl) Generic cough drops Chloraseptic (Sore throat spray) Lice shampoo or scabies cream (Nix or Elimite) Calamine lotion Bismuth subsalicylate (Pepto-Bismol) Laxatives for constipation (Ex-Lax) Hydrocortisone 1% cream Topical antibiotic cream Calamine lotion Aloe

Medical Personnel: Please review the CAMPER HEALTH HISTORY FORM (FORM 1) and complete all remaining sections of this form (FORM 2). Attach additional information if needed.

Diet, Nutrition: " Eats a regular diet. " Has a medically prescribed meal plan or dietary restrictions:(describe below)

The camper is undergoing treatment at this time for the following conditions: (describe below) " None.

Medication: " No daily medications. " Will take the following prescribed medication(s) while at camp: (name, dose, frequency—describe below) !

Other treatments/therapies to be continued at camp: (describe below) " None needed.

Do you feel that the camper will require limitations or restrictions to activity while at camp?!" No " Yes If you answered “Yes” to the question above, what do you recommend? (describe below—attach additional information if needed)

“I have reviewed the CAMPER HEALTH HISTORY FORM (FORM 1), and have discussed the camp program with the camper’s parent(s)/guardian(s). It is my opinion that the camper is physically and emotionally fit to participate in an active camp program (except as noted above.) Name of licensed provider (please print): __________________________________Signature: _________________________________Title: _________ Office Address_____________________________________________________________________________________________________________ Street

City

Telephone: (________)_____________________ Copyright 2008 by American Camping Association, Inc.

State

Zip Code

Date:_______________________ Rev. 2/07 LEE/EAW

Camper Name ______________________________________________________________________ (For Camp Use) Cabin or Group____________________ (For Camp Use) Session Code(s): ________________

CAMPER HEALTH-CARE RECOMMENDATIONS by LICENSED MEDICAL PERSONNEL FORM 2

06/01

Maine Golf & Tennis Academy 35 Golf Academy Drive Belgrade, Maine 04917


Maine Golf & Tennis Academy

MEDICAL C - Camper Health History (2)

Maine Golf & Tennis Academy

MEDICAL C - Camper Health History (3)


Maine Golf & Tennis Academy

Maine Golf & Tennis Academy

MEDICAL E: Parent Permission Form

MEDICAL: Maine State law 2496

PARENT PERMISSION FORM

A Maine State Law

USE OF SELF-ADMINISTERED EMERGENCY MEDICATION As the parent or guardian of _____________________________________, during his/her time at camp, (Camper Name) the above listed camper is permitted to have readily available (carry or possess outside of the regular supervision of the camp’s health staff) self-administer as medically necessary: (Circle all that apply or list other emergency self-medication device.)

a. Asthma Inhaler

b. Epinephrine Pen

c. Other (please list) ____________________________________

I have read the State of Maine Law as listed below, and confirm that my child has the knowledge and the skills to safely have readily available and self-administer the indicated emergency medication in camp. ___________________________________________ ____________ Parent or Guardian signature Date

Summary of Maine Law on Self Administration of Emergency Medications Recreational camps for children; emergency medication. A recreational camp for boys or girls must have a written policy authorizing campers to self-administer emergency medication, including, but not limited to, an asthma inhaler or an epinephrine pen. The written policy must include the following requirements: A. A camper who self-administers emergency medication must have the prior written approval of the camper’s primary health care provider and the camper’s parent or guardian; B. The camper’s parent or guardian must submit written verification to the camp from the camper’s primary health care provider confirming that the camper has the knowledge and the skills to safely self- administer the emergency medication in camp; C. The camp health staff must evaluate the camper’s technique to ensure proper and effective use of the emergency medication in camp; and D. The emergency medication must be readily available to the camper. The full statute may be viewed at: http://janus.state.me.us/legis/statutes/22/title22sec2496.html

That could affect your child while attending a Maine camp The State of Maine has passed a law that affects all campers who need to have readily available (carry or possess outside of the regular supervision of the camp’s health staff) and to self-administer emergency medication while at camp. The law establishes procedures to allow such access to emergency medication by those campers who have been diagnosed to be at risk for a potential medical crisis such as asthmatic attacks or allergic reactions. These medications include, but are not limited to, an asthma inhaler or an epinephrine (epi) pen. To comply with State Law 2496, all Maine camps are required to have a written policy authorizing campers to have readily available and to self-administer such emergency medications where the following conditions are met: A. Any camper who self-administers emergency medication must have the prior written approval of the camper’s primary health care provider and the camper’s parent or guardian; B. The camper’s parent or guardian must submit written verification to the camp from the camper’s primary health care provider confirming that the camper has the knowledge and the skills to safely self- administer the emergency medication in camp; C. The camp health staff must evaluate the camper’s technique to ensure proper and effective use of the emergency medication in camp; and D. The emergency medication must be readily available to the camper. If your child needs to, and you want to permit your child to have readily available (carry or possess outside of the regular supervision of the camp’s health staff) and to self-administer an inhaler, an epi-pen or other emergency medication, you and your camper’s primary health care provider must complete and return to us the forms provided with this letter. These forms were developed in cooperation with the Maine Youth Camping Association. When your camper arrives at camp our health staff are required to evaluate the camper’s self administration technique to ensure proper and effective use. These forms are not necessary for those campers who do not need to have readily available and to selfadminister emergency medications. As always our health staff will provide regular supervision of prescription medications for campers. All forms should be submitted by June 1, 2006. As always, please call with any questions or concerns. Thank you in advance for helping us comply with this new law.

O:\JPE\53517-200 MYCA Legis\Epi-pen Law 2006\Emergency meds cover draft 2 jpe rev060421rl.doc


Maine Golf & Tennis Academy

Maine Golf & Tennis Academy

TRANSPORTATION FORM: ARRIVALS

MEDICAL: Additional Information

Please complete and return this Form by May 1st so we can make the appropriate arrangements. Thank you.

Camper’s Name: _________________________ Age: _____ Session Attending: ________ Check which Arrangement(s) Apply to you and Complete ALL Requested Information:

DRIVING TO CAMP: Arrivals are scheduled between 2:00 pm and 4:00 pm I will drive my child to The Maine Golf & Tennis Academy to arrive on (Day) ________________ (month) ___________ (date) ______ at (time) ____________________ If you arrive at a day or time other than the scheduled day and/or time you will not receive the benefits of our scheduled Intake Program.

FLYING TO AIRPORT: Arrivals that are scheduled between 11:00 am and 3:00 pm on arrival dates

My child will arrive at the Airport (via flight or parent drop off) and I am requesting MGTA to meet and assist my child and provide Transportation to camp. My child arrives on:

(Day) ________________ (month) __________ (date) ______

at (arrival time) ______________

Airline _____________________________________

Flight Number

Departure City, State, Country

Departure Time

FROM (Circle Airport and fees)

BOSTON, Massachusetts (BOS) PORTLAND, Maine (PWM) AUGUSTA, Maine Boston Logan Airport Portland International Airport Private JetPort Fee: $175.00 (One way) No Fee (One way) No Fee (One way)

Arrivals on days other than Regular Scheduled Arrival Dates or times incur an additional Pick Up Fee BOSTON $200.00 (One way) PORTLAND $100.00 (One way) AUGUSTA $60.00 Arrivals on scheduled Intake Days at non-scheduled times incur an additional fee

____My child will be flying as an UNACCOMPANIED MINOR to MGTA and all necessary additional charges will be paid for by me, the parent or guardian. Signature of Parent ___________________________________

BUS/VAN SERVICE TO CAMP: Arrivals are scheduled as outlined below

Van for 1 to 14 passengers, 45 passenger commercial private bus for 15-44 registrants. FEE: $200.00 One Way. Provide your cell number for contact purposes: ____________________________

___ Intake Day Session A - From Darien, CT at 9:00 am to arrive in camp at 5:00 pm

Pick up at the McDonald’s Rest Stop (just past exit 12 going North on I-95)

___ Intake Day Session B - From Darien, CT at 9:00 am to arrive in camp at 5:00 pm

Pick up at the McDonald’s Rest Stop (just past exit 12 going North on I-95)

LUGGAGE: All Bags must be shipped to camp to arrive one week BEFORE your child's session. All luggage must be shipped two weeks in advance by UPS or Federal Express. Clearly address each piece to your child at the camp address and attach all labels securely. If you need assistance please contact The Mailing Center at 207-621-0234 or on line at www.mailingctr.com. WE DO NOT TRANSPORT ANY DOMESTIC LUGGAGE other than 1 carry on bag per child. Any special arrangements outside this policy incur an additional fee of $60.00 or more. Please complete the enclosed Request Form.

ABSOLUTELY NO CHANGES OR ADDITIONS to arrival arrangements will be accepted unless they are received by MGTA on a NEW ARRIVALS FORM , signed & dated, at least two weeks prior to arrival date.

Parent's Signature _____________________________________________

Date:__________________

© January 27, 2012 This form is accurate at the date of printing. See website www.golfcamp.com for the most up to date and official dates, fees and information.


Maine Golf & Tennis Academy

Maine Golf & Tennis Academy

TRANSPORTATION FORM: DEPARTURES

TRIPS/PROGRAM PERMISSION FORM

Please complete and return this Form by May 1st so we can make the appropriate arrangements. Thank you.

Camper’s Name: _________________________

Age: _____

Session Attending: ________

Check which Arrangement(s) Apply to you and Complete ALL Requested Information: I will drive my child from The Maine Golf & Tennis Academy to depart on (Day) ________________ (month) ___________ (date) ____________ at (time)

If you depart on a day or time other than the scheduled day and/or time you will not receive the benefits of our scheduled Departure Program.

FLYING FROM AIRPORT: Departures are scheduled between 11:00 am and 3:00 pm

I am requesting MGTA staff transport and assist my child to meet the following flight or parent pick up from the airport as indicated below. My child departs on:

(Day) ________________

(month) ___________

Airline _____________________________________

Destination City, State, Country

(date) ______ at (depart time) ______________

Flight Number

Arrival Time

FROM (Circle Airport and fees)

BOSTON, Massachusetts (BOS) PORTLAND, Maine (PWM) Boston Logan Airport Portland International Airport Fee: $175.00 (One way) No Additional Fee (One way)

Departures on other than regular Scheduled Departure days and times incur an additional Drop off Fee BOSTON $200.00 (One way) PORTLAND $100.00 (One way) AUGUSTA $60.00

AUGUSTA, Maine Private JetPort No Fee (One way)

Departures on scheduled days at non-scheduled times incur an additional fee ____My child will be flying as an UNACCOMPANIED MINOR from MGTA and all necessary additional charges will be paid for by me, the parent or guardian. Signature of Parent _______________________________________________

BUS/VAN SERVICE FROM CAMP: Departures are scheduled as outlined below

Camper’s Name: _________________________

TRIPS PERMISSION:

DRIVING FROM CAMP: Departures are scheduled from 9:00 - 11:00 am.

Please complete and return this Form by May 1st so we can make the appropriate arrangements. Thank you.

Van for at least 6 passengers, 45 passenger commercial private bus for 15-43 registrants. FEE: $200.00 One Way. Provide your cell number for contact purposes: ________________________

___ End of Session A - From camp at 8:30 am to arrive in Darien, CT at 4:00 pm Drop off 1st Session at the McDonald’s Rest Stop (near exit 12 going South on I-95) ___ End of Session B - From camp at 8:30 am to arrive in Darien, CT at 4:00 pm Drop off at the McDonald’s Rest Stop (near exit 12 going South on I-95)

LUGGAGE: All Bags will be shipped from camp within 2 days following your child's Departure. ___ I am driving my child from camp and will take the luggage with us. ___ My child is taking an international flight and checking luggage. I am responsible for all luggage fees. On departure you must make arrangements to ship all luggage home using the Mailing Center; please contact them at 207-621-0234 or via www.mailingctr.com to make these arrangements.

WE DO NOT TRANSPORT LUGGAGE other than 1 carry on bag per child. Any special arrangements requested outside

Age: _______ Session Attending: ________

Please check all that apply and sign below

My child is coming for a Half Session and has permission to participate on the following trip(s): _____ Day Trip: Samples include Lobster Pound, Hiking Mt. Battie, Smalls Falls Beach, etc. _____ White Water Rafting - NOTICE: this trip may run during scheduled instruction and/or play time; therefore, attending this trip may decrease your childs instruction/play time by one full day. Additional Fee of $125.00 My child is coming for a Full Session or Full Season and has permission to participate on the following trip(s) _____ Day Trip: samples include Lobster Pound, Hiking Mt. Battie, Smalls Falls Beach, etc. _____ White Water Rafting - NOTICE: this trip may run during scheduled instruction and/or play time; therefore, attending this trip may decrease your childs instruction/play time by one full day. Additional Fee of $125.00 _____ Overnight Camping Trip: Samples include Bar Harbor, Castle Island _____ Recreational/Shopping Trip: Samples include LL Bean, Freeport, Portland Sea Dogs Game Fees: Some trips may incur an additional fees - See website for most current information. Specific Trips may change as necessary.

Parent/Guardian Signature* ______________________________________

Date: _________________

*In signing above I give permission for my child to participate in the trips and activities I have indicated in full understanding that these activities might have risks and dangers connected with them; however, I release Kennebec Camps Maine Golf & Tennis Academy, its Directors, and all its agents and staff from any legal actions or claims that my child, I, or the legal guardian might have for damage or injury to the child named above or any personal property arising from participating in the trips and activities. I realize that No Refunds for Trip Fees will be given for any reason including Partial Attendance of Camp Session(s), and No Refunds will be given after May 1st.

SPECIALTY PROGRAMS: Please check all that apply and sign below _____ My child is requesting participation in the following Specialty Pogram(s) and/or Activities _____ ADVANCED GOLF - GOLD: My child is 13 years or older and has a handicap of 16 or less Additional fees apply - $695.00 for Full Session, $395.00 for Half Session _____ ADVANCED GOLF - BLACK: My child is 12 years or younger and has a handicap of 24 or less Additional fees apply - $695.00 for Full Session, $395.00 for Half Session _____ ADVANCED GOLF - BLUE: My child is 12 - 17 years old has the desire & ability to focus fully on golf Additional fees apply - $695.00 for Full Session, $395.00 for Half Session _____ ELITE TENNIS: My child is at least 12 years old has the equivalent to a 4.0 or higher NTRP Rating Additional fees apply - $1,500.00 for Full Session, $800.00 for Half Session Qualifications for each of the Programs listed above will be further assessed and verified upon arrival. _____ GOLF LITE, TENNIS LITE or SERVE & TURF LITE: No additional fees apply _____ ESL LESSONS: 5 days/week, 1 hour/day during rest hour - tought by Professional Instructors No additional Fees apply All Fees Subject to Change: See website for most current information

this policy incur an additional fee of $60.00 or more. Please complete Requests Form.

ABSOLUTELY NO CHANGES OR ADDITIONS to departure arrangements will be accepted unless they are received by MGTA on a NEW DEPARTURES FORM , signed & dated, at least two weeks prior to departure date.

Parent's Signature _____________________________________________

Parent/Guardian Signature* ______________________________________

Date: ___________________

*In signing above I give permission for my child to participate in the activities I have indicated. I realize that No Refunds for Program and/or Activity Fees will be given for any reason including Partial Attendance of Camp Session(s), and No Refunds will be given after May 1st.

Date:_________________

© January 27, 2012 This form is accurate at the date of printing. See website www.golfcamp.com for the most up to date and official dates, fees and information.

© January 27, 2012 This form is accurate at the date of printing. The website www.golfcamp.com always has the most up to date and official dates, fees and information.


Maine Golf & Tennis Academy

Maine Golf & Tennis Academy

EQUIPMENT RENTAL/REQUESTS

GOLF LEVEL DETERMINATION

Please complete and return this Form by May 1st so we can make the appropriate arrangements. Thank you.

Camper’s Name: _________________________

Age: _____ Session Attending: _________

EQUIPMENT/SUPPLY RENTAL: Please check all that apply and sign below My child is requesting the following equipment be loaned to him or her upon arrival at camp: _____ GOLF CLUBS/BAG: Appropriate number and size clubs with carry bag will be provided. (Please circle) SIZE: JR or ADULT Handed: LEFT RIGHT

(#) _____ Weeks

(#) _____ Weeks

Additional fees apply - $150.00 for Full Session, $100.00 for Half Session All Fees Subject to Change: See website for most current information

Parent/Guardian Signature* ______________________________________

LEVEL DETERMINATION: GOLF

PREVIOUS CAMPERS: 1. How many summers have you spent at the Maine Golf & Tennis Academy? ___________________________________ 2. At what level of instruction were you playing last summer? (Please Circle)

Additional fees apply - $150.00 for Full Session, $100.00 for Half Session _____ BED LINENS: Includes twin size sheets, blanket, pillow and pillow case.

Camper’s Name: _________________________ Age: _____ Session Attending: ________

Date: ____________

* I realize that No Refunds for Rental Fees will be given for any reason including Partial Attendance of Camp Session(s), and No Refunds will be given after May 1st.

SPECIAL REQUESTS: Please indicate special needs below and sign We have tried to predict and provide for all your conceivable needs and requests; however, each year we come across some new and unforseen circumstance. Please indicate below if there are any additional requests or needs you or your child are making and we will let you know if and how we will be able to fulfill your request. (Example: Luggage shipment on unscheduled day/luggage transport.)

I am making the following request in hopes that you will be able to fulfill it:

RED

WHITE

BLUE

BLACK

GOLD

3. What is your current handicap? ____________________ 4. What is your 9-hole score improvement over last summer? _________________________________________________

LEVEL DETERMINATION: If your 9-hole score has improved by more than three strokes you should circle the next level up (Red last year advances to White this summer, White to Blue). If your new handicap qualifies you to participate in either Black or Gold and you want to opt for one of these Adanced Programs please complete the Advanced Program Selection Form. Additional Fees Apply. If you were a Gold Level Player last year and your scores are either maintining or improving you will be moved up within the Gold Level this summer.

Please Circle the Level you will be most likely be playing this summer:

RED

WHITE

BLUE

BLUE Advanced

BLACK

GOLD

NEW CAMPERS: Please circle the most accurate answer

Describe Below:

BLUE Advanced

RED

to each question

1. How many years have you been playing golf?

WHITE

BLUE

BLUE Adv.

BLACK

under 12

GOLD

13 or older

0

<1

1

1

>1

>2

2. Number of 9-hole rounds played this past year?

<5

<6

<7

>7

>8

>10

3. What is your averge 9-hole score?

>54

45-50

39-44

39-44

>42

>38

4. Are you taking golf lessons (How Many)?

0-4

4-8

8-10

10-12

>12

>16

5. Are you playing on a golf team?

NO

NO

NO

Trying out

YES

YES

6. Do you participate in golf tournaments?

NO

NO

NO

Trying to

YES

YES

None

Little

Some

YES

Great

Great

Which One: _____________________

NO

NO

NO

YES

YES

YES

7. Desire to improve your competitive position? 8. Have you been to a golf school before?

Circle the Level Color (Red, White, Blue, Blud Adv., Black, Gold) with the most circled answers in its column.

ADDITIONAL INFORMATION:

Parent/Guardian Signature* ______________________________________

Date: _______________

* I realize that this request may not be able to be fulfilled and may incur an additional fee that will be outlined prior to arrival. No Refunds of any kind will be given after May 1st. © January 27, 2012 This form is accurate at the date of printing. The website www.golfcamp.com always has the most up to date and official dates, fees and information.

Are you Left Handed or Right Handed? (Please Circle) LH RH Please provide any other information you would like us to consider. __________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ The LEVEL you circled will most likely be the Level at which your child will study golf this summer. All Level Determinations will be finalized by our Pros' Evaluation and Assessment upon your child's arrival at camp.


Maine Golf & Tennis Academy

Maine Golf & Tennis Academy

ACTIVITIES: CUSTOMIZED CURRICULUM

TENNIS LEVEL DETERMINATION Camper’s Name: _________________________ Age: _____ Session Attending: ________

Camper’s Name: _________________________ Age: _____ Session Attending: ________

LEVEL DETERMINATION: TENNIS

Please circle the Program in which you are enrolled and the proposed Level of study* you have determined best suits your child:

PREVIOUS CAMPERS: 1. How many summers have you spent at the Maine Golf & Tennis Academy? ___________________________________

PROGRAM:

GOLF

2. At what level of instruction were you playing last summer? (Please Circle)

LEVEL:

RED

RED

WHITE

BLUE

BLACK

GOLD

TENNIS WHITE

LEVEL DETERMINATION: If your match play has improved by more than three wins you should circle the next level up (Red last year advances to White this summer, White to Blue, Blue to Black - 12 and under, or Black - 13 and older). If your wins qualify you to participate in either Black or Gold and you want to opt for one of these Adanced Programs please complete the Advanced Program Selection Form. Additional Fees Apply. If you were a Gold Level Player last year and your scores are either maintining or improving you will be moved up within the Gold Level this summer.

Please Circle the Level you will be most likely be playing this summer: WHITE

BLUE

BLACK

GOLD

NEW CAMPERS: Please circle the most accurate answer

to each question

RED

WHITE

BLUE

BLACK

under 12

GOLD 13 or older

1. How many years have you been playing tennis?

0

>1

1

>1

>2

2. Number of matches/sets played this past year?

>3

4-7

7-10

>10

>12

3. Are you taking tennis lessons (How Many)?

0-4

5-10

11-16

>16

>20

4. Are you playing on a tennis team?

NO

NO

Trying out

YES

YES

5. Do you participate in tennis tournaments?

NO

NO

Trying to

YES

YES

None

Little

Yes

Great

Great

NO

NO

Yes

YES

YES

6. Desire to improve your competitive position?

Which One: _____________________

7. Have you been to a tennis school before?

BLUE ADVANCED

YES

BLACK

NO GOLD

OTHER ACTIVITIES

4. Describe your improvement over last summer? __________________________________________________________

RED

BLUE

LITE:

ELITE TENNIS

3. What is your current NRTP Rating? ____________

Golf/Tennis Combo

Circle the Level Color (Red, White Blue, Black, Gold) with the most circled answers in its column.

Please rank the top six activities in which you want to participate and place a number one through six in the space provided before each activity in order of preference - 1 being your first choice, (want to do this activity the most) to 6, your last choice.* Your answers let us know which activities to plan for you during time away from mandatory golf and/or tennis.

SPORTS _____ Additional GOLF _____ Additional TENNIS _____ HOCKEY _____ Fitness (Running) _____ Soccer _____ Basketball

_____ Field Games (Ultimate Frisbee, FOLF, Kickball, Softball) _____ Net Games (Volleyball, Badminton, Beach Tennis, Ping Pong) _____ Ropes Course (Climbing Wall, High & Low Ropes) _____ Archery _____ Street Hockey _____ Mountain Biking

WATERFRONT

_____ Swimming: Trampoline, Lessons, Laps, FREE Swims _____ Small Craft Boating: Canoes, Kayaks _____ Waterskiing: Wake Boarding, Knee boarding, Tubing

_____ Sailing _____ Fishing _____ Aqua Golf

ARTS & LEISURE

_____ Arts & Crafts (Studio Art, Jewelry Making, Ceramics) _____ Newsletter _____ Dance (Modern, Aerobics) _____ Radio _____ Outdoor Living (Camping, Survival Skills, Hiking) _____ Photography _____ Nature Skills (Gardening, Sustainable Living) _____ Videography _____ Music (Band, Singing, Guitar) _____ Cooking _____ Theater (Stage Design, Acting, Play writing) _____ Yoga

,

ADDITIONAL INFORMATION:

Please indicate below any Activities of interest to you that are not offered above:

Are you Left Handed or Right Handed? (Please Circle) LH RH Please provide any other information you would like us to consider. __________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________

_______________________

The LEVEL you circled will most likely be the Level at which your child will study golf this summer. All Level Determinations will be finalized by our Pros' Evaluation and Assessment upon your child's arrival at camp.

_______________________

_______________________

*PLEASE REMEMBER We will do our best to schedule all your desired activities; however, the interests of your fellow campers will help determine our offerings so you may not receive all of your requests.

& All Level Determinations will be finalized by our Pros' Evaluation and Assessment upon your child's arrival at camp.


Maine Golf & Tennis Academy

UNIFORM ORDER FORM Camper’s Name: _________________________

Age: _____ Session Attending: ________

Parent/Guardian Signature* ______________________________________

Date: ____________

GOLF Required Uniform: 6 Polos, 1 T-Shirt, 1 Windshirt, 1 Cap, Water Bottle TENNIS Required Uniform: 2 Polos, 5 T-Shirts, 1 Windshirt, 1 Cap, Water Bottle SERVE & TURF Req’d Uniform: 5 Polos, 4 T-Shirts, 1 Windshirt, 1 Cap, Water Bottle (Combination Golf & Tennis)

Cost $300.00 Cost $300.00 Cost $350.00

ADULT SIZE MALE CAMPERS Dry-Fit Tech Polo White:

Sizes Available: S M L XL XXL

$34.95 each

Size:_____ #: ____

Dry-Fit UV Crew White:

Sizes Available: S M L XL XXL

$19.95 each

Size:_____ #: ____

Water Resistant 1/2 Zip Wind Jacket Black:

Sizes Available: S M L XL XXL

$64.95 each

Size:_____ #: ____

Tech Structured Cap Black

One Size $15.95 each

Size:_____ #: ____

MGTA Water Bottle $9.95

Check here to order this packet and indicate your child’s size _______

(Circle)

#: ____

Golf

Tennis

S&T

ADULT SIZE FEMALE CAMPERS Dry-Fit Tech Polo White:

Sizes Available: XS S M L XL XXL

$34.95 each

Dry-Fit UV Crew White:

Sizes Available: XS S M L XL

$19.95 each

Water Resistant 1/2 Zip Wind Jacket Black:

Sizes Available: XS

Tech Structured Cap Black

One Size $15.95 each

S M L XL

Size:_____ #: ____ Size:_____ #: ____

$64.95 each

Size:_____ #: ____ Size:_____ #: ____

MGTA Water Bottle $9.95

Check here to order this packet and indicate your child’s size _______

(Circle)

Golf

#: ____

Tennis

S&T

YOUTH SIZE CAMPERS: Male/Female Dry-Fit Tech Polo White:

Sizes S(8-10) M(10-12) L(12-13) XL(13-15)

$34.95 each

Size:_____ #: ____

Dry-Fit UV Crew White:

Sizes S(8-10) M(10-12) L(12-13) XL(13-15)

$19.95 each

Size:_____ #: ____

Water Resistant 1/2 Zip Wind Jacket Black: Sizes S(8-10) M(10-12) L(12-13) XL(13-15) $64.95 each

Size:_____ #: ____

Tech Structured Cap Black

Size:_____ #: ____

One Size $15.95 each

MGTA Water Bottle $9.95

Check here to order this packet and indicate your child’s size _______

(Circle)

Golf

#: ____

Tennis

Additional items or items bought in numbers less than full packages are charged at prices listed above. You must purchase these Nike product logo’d uniform items through MGTA. Please complete, sign, and return this form to MGTA as soon as possible. Fax # 1-207-465-2822

S&T


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