NUSEA Summer 2015

Your child has been invited to participate in the NUSEA Squash Camp hosted at the S. L. Green StreetSquash Center. Come improve your squash skills, enjoy the Big Apple, and meet urban squash players from around the country!

StreetSquash NUSEA Camp offers:

SQUASH • Adult coaches & veteran StreetSquash team members are on hand to

offer expert lessons. CULTURAL EXPOSURE • Exciting field trips to sites across New York City. • Learn about diverse cultures and experiences in NY. Program dates – (Sunday-Friday): First Day: Sunday, August 16th: Check-in/pick up from 1PM to 3PM Final Day: Friday, August 21st: Closing remarks/drop-off at 12PM Times: Each day will begin at 10AM and end at 4PM (excluding arrival and final day).

Host parents are responsible to get their children and host children to and from the S.L. Green StreetSquash Center on 40 West 115th Street

between Lenox and Fifth Avenue.

If you have any questions, please feel free to contact StreetSquash at (212) 289-4838 x210.

STREETSQUASH NUSEA CAMP

Child Name: _______________________________ School: ____________________ Birth Date: ___________________ Male [ ] Female [ ]

Health: excellent [ ] good [ ] fair [ ] poor [ ] Grade _________

Health concerns / medication: ______________________________________________

Parent / Guardian Name(s): ________________________________________

Address:  ________________________  Apt.______  Borough:  ___________  Zip:  _______   Phone Numbers/Email: Home: (_____) ____________________

Guardian(s) Work: (_____) ____________________; Name __________________

(_____) ____________________; Name __________________

Guardian(s) Cell: (_____) ____________________; Name _________________

(_____) ____________________; Name _________________

Child Cell: (_____) ____________________

Child E-mail ___________________ Guardian E-mail __________________

Emergency Contact:

Name: ______________________ Relationship: ___________________

Phone#: (work) (___)______________ (home) (___)____________

LIABILITY WAIVER StreetSquash, StreetSquash staff, and the participating squash facility shall not be liable for any claims, demands, damages or injuries to the student noted above (1) resulting from his/her participation in StreetSquash practices or (2) in connection with the student’s use of the club, equipment, or premise where these practices take place.

Student noted above and his/her parent/legal guardian shall save StreetSquash, StreetSquash officers, director, employees and agents and the participating club(s) harmless from and indemnify StreetSquash officers, directors, employees and agents and the participating club(s) against all injury, loss or damage of whatever nature (1) resulting form the student’s participation in StreetSquash practices or (2) in connection with the student’s use of the club, equipment, or premise where these practices take place.

Parent/Guardian Signature: _______________________ Date: _________

NUSEA CAMP MEDICAL INFORMATION FORM

ALLERGIES/HEALTH CONDITION: CHILD’S NAME: ADDRESS: PHONE: ( ) EMERGENCY PHONE: Parent/Guardian Acknowledgement: In the event that my child is injured and/or becomes seriously ill during this event, I do grant permission for my child to be seen by a doctor. Please provide StreetSquash with all necessary insurance information so that we may be able to provide the physician with this necessary information in the event of injury or illness. The applicant is in good health and able to participate in the activities of the event. Insurance Carrier and Policy/group #: ________________________________________ Signature of Parent/Guardian: _________________ Date: _________________________ Over-The-Counter Medicine Waiver: [ ] I allow a StreetSquash staff member to give over-the-counter medication such as Advil to my child when both the staff member and the child deem it appropriate. This medication will only be distributed by a staff member, who will administer only the recommended dosage. [ ] I do not allow a StreetSquash staff member to administer medication to my child under any circumstance.

General Information

Camp Begins: Sunday, August 16th, 2015 Camp Ends: Friday, August 21st, 2015 Camp Facility: StreetSquash Center, 40 West 116th Street New York, NY 10026 Housing: Participants will be provided with homestays Camp Directors: Edgardo Gonzalez (Squash Director) Contact Information: StreetSquash Center (212)-289-4838

Packing List 1 pair of non-marking athletic shoes 1 pair of running shoes At least one squash racquet 5 pairs of athletic shorts/skirt 5 athletic t-shirts $20-$40 Spending money for souvenirs Toiletries (soap, shampoo, deodorant, etc.) Towel StreetSquash is not responsible for any lost or stolen valuables