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INDIANA SWIMMING CAMPS

Oct. 7, Bloomington, Indiana
Counsilman Billingsley Aquatic Center

CAMP COSTS

$300.00*

CAMP DETAILS

- Open to Boys and Girls 14-18

- Camper must be USA Swimming registered

- Registration - Oct. 7, 9:30 a.m.

- Free cap, t-shirt

-  Camp runs from 10 a.m.- 12 p.m., 2-4 p.m.

- Campers responsible for travel, lunch/snacks

 

CAMP DETAILS

- Download 2017 Breaststroke Clinic Flyer: Click Here!

ADDITIONAL INFORMATION:

** This summer, we are offering an Elite segment as an option for 13 years and older. This segment of camp will feature an extra training session with a coach in the morning from 6-8 a.m. To learn more and participate in this Elite group, contact the Indiana Swim Camp soon after you register to reserve your spot! Space is limited!
Open to Ages 8-18

FOR REGISTRATION INFORMATION/INQUIRIES:

  • Office: 812-333-5684
  • E-Mail: For Further Information!
  • Mailing Address: Indiana Swim Camp; 2344 E. Linden Hill Rd.; Bloomington, IN 47401
  • Download 2017 Camp Brochure - Click Here!
  • Register On-Line: Now Available!


  • Add 6% for on-line registrations

    For questions about age restrictions, please E-Mail Us


      All Indiana Camps are open to all and any entrants



      2017 Indiana Fall Breaststroke Clinic

      Sold Out - No additional registrations can be accepted.


      INDIANA FALL BREASTSTROKE CLINIC REGISTRATION - OCTOBER 7, 2017

      Registration Note - Registrations will be accepted until the camp is full. No refunds or cancellations will be accepted after Sept. 20, 2017. Cancellations received before Sept. 20 will receive a refund of the registration fee minus a $75 administrative fee. No refunds will be made if a child is withdrawn after May 15.

      If you have questions, please call 812-333-5684.

      Please complete the form below and submit camp payment.

       
      Payment Option*
       Credit Card
       Mailing in Check*
       
      * If you are mailing in a check, completely fill out this form and click on the 'register' button at the bottom of the page. On the next page, you can exit your web browser. Then, you can mail in your check made payable to Indiana Swim Camp to: Indiana Swim Camp; 2344 E. Linden Hill Rd; Bloomington, IN 47401. As a reminder, the rate is $300. In the memo line of your check, please indicate the name or names that payment is for, and which session you have signed up for.  
      Camper's Name (Last, First)*
       
      Home Address*
       
      City*
       
      State*
       
      Zip*
       
      Parent/Guardian Name(s)*
       
      Camper's Home Phone #*
       
      Parent's Cell Phone #
       
      Parent's E-Mail Address*
       
      Age*
       
      HS Graduation Year (i.e. 2020)*
       
      Birthdate (Month/Day/Year)*
       
      Gender*
       
      Name of Club Team
       
      Club Team Coach's Name
       
      Best Time 50 Breaststroke
       
      Best Time 100 Breaststroke
       

      MEDICAL CONSENT FORM
      In order to enable the IU Health Center of Indiana University and/or other health facilities in Bloomington to provide prompt care to your minor son or daughter, please read and complete the below consent form. This way we can help your child without delay should an emergency occur. Additionally,please send us a copy of your child's insurance card and enclose it when returning all forms prior to your child's arrival at swim camp.
       
      Name of Minor*
       
      Insurance Company*
       
      Policy Number/Group #*
       
      Name of Policy Holder*
       
      Food Allergies
       
      Drug Reactions
       
      Present Medication (include dosage)
       
      Date of Last Tetanus Toxoid
       
      Any past or present illness, or injury or other information that would be useful in the event that treatment is needed
       
      Name and # to call if parent can't be reached*
       

      * I grant permission to the director, assistants, or other persons responsible for said minor to act on my behalf for said minor in granting permission for evaluation and treatment of medical problems. I understand that should a major medical problem arise, an attempt will be made to notify me by telephone. In the event that I cannot be reached, I hereby give my consent to such treatment as deemed necessary (including surgery, x-ray examinations, and anesthesia to be rendered to said minor by a licensed physician or nurse)  

      * I do herby, waive, release and discharge the Indiana Swim Camp, Forward Marketing LLC and respective staffs, employees, successors and assigns,of and from any and all rights and claims for damage resulting from injury of my person or property, which may be or arising out of my travelling to or from the Indiana Swim Camp. I/we, the parents/guardians, agree to the above waiver and release and we join therein.  

      * By my submission of this registration, I represent that I am either 18 years of age or older, or that I am the parent or legal guardian of the registrant (if he/she is under age 18). I represent I have read the terms of the Privacy Policy, that I understand the manner in which the information collected about the registrant may be used, and that I agree to the use of the registrant’s personally identifiable information in the manner described in the Privacy Policy.  

      Parent/Guardian Name*
       
      Date*
       


      PAYMENT OPTIONS
      Please select your payment option by indicating a '1' in the quantity field. We need a registration form and consents completed for each participant.

      Note: A charge from Hoosiersportscamps.com will appear on your credit card for your on-line registration. However, if any of the Indiana Swim Camps are canceled for any reason, refunds must be collected directly from Indiana Swim Camp, 2344 Linden Hill Rd., Bloomington, IN 47401. Phone 812-333-5684.
       
      Qty 
       $318.00 Individual Registration - Payment in Full