Online Registration Form

TELEPHONE NUMBER
IN CASE OF EMERGENCY

*Emergency Phone:

Online Registration
& Payment

To register by mail or in person, click here to download
an application form you can print out and fill in.

Player's Information

Parent's Name, Address & Contact Information

* Denotes Required Information
First Name: Last Name: Mr/Mrs/Ms/Dr:

Street Address: City: State: Zip:

[Please enter area code and telephone number in the format: XXX-XXX-XXXX]
Day Phone: Cell Phone:
E-Mail Address: Re-Enter E-Mail Address:

Camp Session Selection

Camp Pricing Plans
*ALL CAMPS . . . . $110.00* PER SESSION/WEEK		*FRIDAY LESSONS ....... $30.00 PER SESSION/WEEK* (NOTE: player must be registered for camp that session/week)
*FULL SUMMER DISCOUNT - $560.00 (all 8 sessions/weeks - must be paid in full in advance)*

2 WEEKS (if paid in advance) $220.00 4 WEEKS (if paid in advance) $340.00 6 WEEKS (if paid in advance) $450.00		3 WEEKS (if paid in advance) $270.00 5 WEEKS (if paid in advance) $400.00 7 WEEKS (if paid in advance) $490.00

If you are enrolling more than one child (siblings), we deduct $10.00 per session. (Does not apply to Friday Lessons. You must enroll at least two (2) siblings on the same form to obtain the additional discount.)

Please Be Sure You

Check the boxes below for each player for the Week(s) and Friday Lesson(s) you would like that player to attend. The pricing and and any discounts will be automatically calculated at the bottom of the form.
After reviewing your registration and submitting online payment, please remember to read the PayPal instructions for completing the transaction carefully. You do NOT have to have or create a PayPal account to use the service.

Choose Sessions For Each Player . . .

Camp Registration Summary & Payment . . .

	Player 1 is registered for:
	Camp Weeks
	Friday Lessons	Cost for Player 1: $

	Player 2 is registered for:
	Camp Weeks
	Friday Lessons	Cost for Player 2: $

	Player 3 is registered for:
	Camp Weeks
	Friday Lessons	Cost for Player 3: $

	Player 4 is registered for:
	Camp Weeks
	Friday Lessons	Cost for Player 4: $


	Sub-Total: Camp Sessions & Friday Lessons		$
	No. of Players registered:
	Less: Sibling Registration Discount		$
	Total Balance Due:		$

Parents' Release, Defend, Indemnification and Hold Harmless Agreement


READ THE FOLLOWING DOCUMENT CAREFULLY. IT IS A LEGALLY BINDING CONTRACT.
To: At The Top Camps, LLC We (or I) hereby request that you accept the application for enrollment of our (my) above-named child(ren) in the 2012 At The Top Camps, LLC during the dates set forth in the application and consideration of your acceptance of this application, we (or I) hereby release the City of Margate, NJ / At The Top Camps, LLC, Dan Feld, Director, and all At The Top Camps, LLC agents, servants, employees and contractors from all claims on account of any injuries which may be sustained by our (or my) son / daughter while attending At The Top Camps, LLC. We (or I) agree to defend, indemnify and hold harmless the City of Margate, NJ / At The Top Camps, LLC, Dan Feld, Director, and all At The Top Camps, LLC agents, servants, employees and contractors for any claim which may hereafter be presented by or on behalf of our (or my) son / daughter as a result of any injuries. In consideration of this application being accepted, We (or I), our (my) heirs, executors, and administrators intending to be legally bound, do hereby waive, release, and forever discharge (and defend, indemnify and hold harmless therefrom) any and all rights and claims for damages against the City of Margate, NJ / At The Top Camps, LLC, Dan Feld, Director, and all At The Top Camps, LLC agents, servants, employees and contractors for any and all damages which may be sustained or suffered by us (me) or the above named player(s) in connection with any association or participation in At The Top Camps, LLC, including arising out of traveling to and from the camp. As a condition of this application being accepted, we acknowledge that digital photographs and video may be taken during any camp session and we give At The Top Camps, LLC, permission to photograph or video record each of the minors named in the above application with respect to camp activities and the irrevocable and unrestricted right to use and publish photographs of them, or in which they may be included, for editorial, trade and advertising, and in any manner or medium, without compensation. We also hereby release Photographer and his/her legal representatives and assigns from all claims and liability relating to said photographs. We(I) also certify that we (I) have read, understand, and agree to the refund and rain policies.
This Release, Defend, Indemnification and Hold Harmless Agreement MUST BE ELECTRONICALLY SIGNED BY EACH PARENT by typing his/her name in the space provided below. Both parents or the parent(s) with legal custody must sign to register your child(ren). THIS IS A LEGALLY BINDING AGREEMENT.
*Parent/Legal Custodian Name (signed):
*Parent/Legal Custodian Name (signed):

When you have completed your registration and selections,
click to continue to the Review and Payment Page

TELEPHONE NUMBERIN CASE OF EMERGENCY

TELEPHONE NUMBER
IN CASE OF EMERGENCY