Life Time Camp Change Form - web

Child & Parent Information

LIfe Time Location:*

Child's Full Name ("Minor Participant")*

First Name

Last Name

Parent, Legal Guardian or Authorized Adult Full Name*

First Name

Last Name

Email*

Phone*

Parents Member Number*

What changes do you need to make?*

Cancellation or addition within an existing camp registration. Including switching days within a week you are currently registered for. Change to completed Participation Agreement

Participation Agreement Changes

What change do you need to make to your campers existing Participation Agreement?

Update child's address / contact information Add/Remove an Authorized Pick-up: Authorized pick-ups are individuals over the age of 18 who have the authorization to pick-up your child from camp. They will need to provide a form of legal ID at each pick-up. Add/Remove an Emergency Contact: Emergency contacts are also authorized pick-up's and may also be contacted if an incident occurs while in camp. Update child's allergy or medical conditions

UPDATE CONTACT INFORMATION

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Phone

Email

AUTHORIZED PICK-UP'S

How many Authorized Pick-ups do you need to add or remove?

1 2

Authorized Pick-up

Add Remove

Authorized Pick-up First & Last Name

First Name

Last Name

Authorized Pick-up Phone Number

Authorized Pick-up #2

Add Remove

Authorized Pick-up #2 First & Last Name

First Name

Last Name

Authorized Pick-up #2 Phone Number

EMERGENCY CONTACT

How many Emergency Contacts do you need to add or remove?

1 2

Emergency Contact

Add Remove

Emergency Contact First & Last Name

First Name

Last Name

Emergency Contact Phone Number

Emergency Contact #2

Add Remove

Emergency Contact #2 First & Last Name

First Name

Last Name

Emergency Contact #2 Phone Number

MEDICAL/ALLERGY INFORMATION

Allergy or Medical Update

If adding an allergy, please include severity (mild, moderate or severe), type of allergy and reaction.

Please Read This Agreement

CANCELLATION & ADD A DAY(S) OR WEEK(S) POLICY OVERVIEW – SEE YOUR REGISTRATION AGREEMENT FOR COMPLETE AGREEMENT TERMS, INCLUDING BUT NOT LIMITED TO PAYMENT, CANCELLATION AND REFUND TERMS:

• Cancellations received by Life Time 21 days or more before the first day of camp will receive a full refund.

• Cancellations received by Life Time less than 21 days prior to the first day of the camp will forfeit any paid camp fees.

• Added day(s) or week(s) will be charged at the current camp rate.

• Added day(s) or week(s) registrations are not guaranteed until confirmed by the club due to availability in that week

I UNDERSTAND AND AGREE THAT:

I have a current Kid's Program Camp Agreement and Participation Agreement with Life Time, Inc. ("Life Time") and that this Camp Change Form is subject to the terms and conditions of my current Kids Program Camp Registration Agreement and current Participation Agreement (collectively, "Kid's Camp Agreements) which are applicable to me and the registered Minor Participant listed above and on the Kid's Camp Agreements, including, without limitation, the voluntary cancellation provision(s) which require a 21-day advance notice of termination in order to receive a full refund.
I, as the parent, legal guardian or authorized adult who signed the Kid's Program Camp Registration Agreement and Participation Agreement, have the authority to authorize the above detailed Camp Change and to use the Monthly Payment Method for Scheduled Payments; and, as such, I authorize Life Time to resume or initiate electronic fund transfers from the Monthly Payment method for the added Camp day(s) or week(s) I requested to pay by Scheduled Payments as detailed above and on the confirmation email sent to me upon my submission of the Kid's Program Camp Change Form.
Two weeks before the first day of each Camp, the Monthly Payment Method will be assessed the dues, fees and surcharges (if applicable) for the Camps I have previously registered for and those added upon submission of this Camp Change Form for Kid's Camp on Scheduled Payments, unless I have paid Camp dues and fees in advance.
I continue to be liable for all obligations associated with my Membership, including, without limitation, all obligations in the General Terms Agreement, Member Usage Agreement and Digital Membership Terms (if applicable), available at https://www.lifetime.life by logging into my membership account, clicking on View Account and clicking on Agreement History and Guest and Club Policies available at https://www.lifetime.life/policy/guest-and-club-policy.html.
My current Camp schedule of camps purchased is no longer in effect and my new Camp scheduled emailed to me as amended above is in effect.
My new Camp Registration fees, as provided in the check-out order summary and follow-up email, are due on the date two weeks before the start of the respective camp if I agreed to have the registration fee payment scheduled. Otherwise, I have paid all Summer Camp Registration fees in advance.
If I am making a Camp cancellation change, some benefits, including, but not limited to, additional Kid's Programming, may no longer be available or included.
If I am changing my Camp Registration, I will be responsible for payment of my existing Camp Registrations in addition to any Camp day(s) or week(s) added. All changes are subject to availability in Life Time's sole discretion.
By providing Camp Registration information, including, but not limited to, contact information on this form to Life Time, I consent to Life Time's collection , use and storage of such information, including, without limitation, information pertaining to Additional Members on my Membership including Minor Participants, for the purpose of managing my Membership and Camp Registration.
Taxes (including state or HST) may apply to Summer Camp Registration fees and other Financial Obligations.
Unless otherwise prohibited by law, if the Monthly Payment Method is a credit card Life Time may impose and collect a surcharge each time my credit card is charged, whether in payment of Monthly Membership Dues, Service -Related Fees, Kid's Program Fees, Summer Camp Registration Fees or any other Financial Obligations, whether recurring or non-recurring. The current surcharge is included on the Fee Schedule, as it may be updated and revised from time to time. Notwithstanding the foregoing, the surcharge amount shall not be greater than Life Time's actual cost of acceptance of the credit card or any applicable maximum amount, whichever is less. I further understand that debit cards do not incur any surcharge, and that I may change the Monthly Payment Method from a credit card to a debit card at any time in person at my primary Life Time Center or online by accessing my Life Time member page at my.lifetime.life under "View Account" and selecting "Payment Options".
All capitalized terms within this Membership Chang Form have the meanings given to them in General Terms Agreement, Kid's Registration Agreement or Kid's Participation Agreement.

Signature

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Date

Child & Parent Information

Camp Cancellation or Addition Change Request ("Summer Camp Change(s)")

JANUARY

FEBRUARY

MARCH

APRIL

MAY

JUNE

JULY

AUGUST

SEPTEMBER

OCTOBER

NOVEMBER

DECEMBER

DECEMBER

Participation Agreement Changes

UPDATE CONTACT INFORMATION

AUTHORIZED PICK-UP'S

EMERGENCY CONTACT

MEDICAL/ALLERGY INFORMATION

Please Read This Agreement