WELCOME and thank you for your interest in our Kiwi Country Day Camp Winter Break Kids Camp.
Winter Break is fast approaching...don't let your kids sit at home with nothing to do. Join us for an action-packed week
of fun, sports and games! For boys and girls ages 3-11, Somers Sports & Fitness will be hosting the Kiwi Country
Day Camp Winter Break Kids Camp Feb. 14 and then Feb. 17-21 from 9:30am - 4pm each day.
Our schedule is flexible, so you can enroll in 1-day, 3-day, or 5-day packages. Half day (AM session = 9:30am - 12 Noon
OR PM session = 1:30pm - 4 pm) and Full day options (9:30am - 4pm) for 6-11 year olds.
Activities include: Soccer, Lacrosse, Flag Football, Baseball, Super Soccer Stars, Camp Olympics, Cheerleading, World Cup,
Yoga, Camp Favorites, Pre-K fun & games, and Camp Kiwi's famous Gaga Tournaments! All-Star Staff led by Camp
Kiwi's finest certified instructors. Don't miss out....we're looking forward to a great week!
2014 Kiwi Country Day Camp Winter Break Kids Camp
Camper FIRST Name ______________________Camper LAST name________________________________
Date of Birth _____/______/______ Age ______ Grade________School______________________________
Address _____________________________________ City __________________ST____ ZIP ___________
Mom Name ________________________________ Dad Name_____________________________________
Mom E-Mail ________________________________Dad Email_____________________________________
Home Phone # ________________________ Cell #______________________________________________
Package(s):
Days: 
AM/PM:
5-Day
3-Day
Fri,14
 Mon,17
AM (9:30-12Noon)
1-Day
Tue,18
Wed,19
PM (1:30-4pm)
Th, 20
Fri, 21
FULL DAY (9am-4pm)
Amt $______ Credit Card # _______________________________________________ Exp. Date _________
Sec Code _________ Name on Card__________________________________________________________
Check # ______Amount Paid $______ Mail to: Somers Sports, Winter Camp, 245 Route 100, Somers, NY 10589
Parent/Guardian: I request permission for my child to participate in Somers Sports & Fitness Indoor Kiwi Country Day
Camp Winter Break Kids Camp. I represent that my child is physically able to participate, and further acknowledge that
there are certain risks of injury inherent in the participation in any sport and that such an injury may occur. I hereby
release and discharge Somers Sports & Fitness and Kiwi Country Day Camp and any of its employees from any and all
liability, claims, demands, causes of action, of any sort arising from injury sustained to my child consequent of his/her
participation in Kiwi Country Day Camp Winter Break Kids Camp at Somers Sports & Fitness. I also give permission to the
free use of my child’s/ward’s name, picture, and/or likeness in any article, broadcast or other account of the league,
including but not limited to, promotion of future events or other promotional use.
Parent’s signature:
__________________________________________________
Date:
________________
Email Registration to [email protected] or drop off at Somers Sports & Fitness, 245 Route 100, Somers.