Thanksgiving Week Break Camps 2012 - League Athletics
Thanksgiving Week Break Camps 2012 Participant Name
Gender M/F
Grade
Address Primary Phone
School City State
Date of Birth Zip Code
Email
Primary Contacts: (Will be authorized to pickup child if listed here) Guardian 1: Phone 1: Phone 2: Guardian 2:
Phone 1: Phone 2:
Emergency Contacts: (If Primary Contacts cannot be reached, the following will be permitted to pick up your child) Guardian 1: Phone 1: Phone 2: Guardian 2:
Phone 1: Phone 2:
Authorized to Pick Up Your Child: (Will be authorized to pickup child if listed here) 1: 3: 2:
4:
Prices Per Half Day $30 Activities Included: Soccer, Floor Hockey, Basketball, Kickball, Wiffle Ball Per Whole Day $45 and Tennis 3 Half Days $70 3 Full Days $105 Lunches are not Provided, so Please Pack a Brown Bag lunch..nothing to be heated or refrigerated. We recommend a healthy lunch as well as snacks and can include deli meat sandwiches, fruits, vegetables, etc. We do not permit carbonated sodas, chips, candy or other junk foods. These food types do not provide adequate nutrition and energy necessary for several hours of exercise and fun! How did you hear about us? Referred by a friend: Or circle one: Newspaper Google Walk In Previous Participant School My Team
Thanksgiving Week Break Camps 2012 Please List any Allergies and/or Medical Concerns:
What is your child's favorite sport? What sport is your child most interested in trying? Please Read, Sign, and Submit this Form for your child's first day of camp: In consideration of being allowed to participate in any way in the program, related events and activities, and by signing below, I the undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and/or death. 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation. 3. I willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately. 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS GAME ON SPORTS, LLC, its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Parent's Name (Print)_______________________ Signature___________________Date_________
Gender M/F
Grade
Address Primary Phone
School City State
Date of Birth Zip Code
Primary Contacts: (Will be authorized to pickup child if listed here) Guardian 1: Phone 1: Phone 2: Guardian 2:
Phone 1: Phone 2:
Emergency Contacts: (If Primary Contacts cannot be reached, the following will be permitted to pick up your child) Guardian 1: Phone 1: Phone 2: Guardian 2:
Phone 1: Phone 2:
Authorized to Pick Up Your Child: (Will be authorized to pickup child if listed here) 1: 3: 2:
4:
Prices Per Half Day $30 Activities Included: Soccer, Floor Hockey, Basketball, Kickball, Wiffle Ball Per Whole Day $45 and Tennis 3 Half Days $70 3 Full Days $105 Lunches are not Provided, so Please Pack a Brown Bag lunch..nothing to be heated or refrigerated. We recommend a healthy lunch as well as snacks and can include deli meat sandwiches, fruits, vegetables, etc. We do not permit carbonated sodas, chips, candy or other junk foods. These food types do not provide adequate nutrition and energy necessary for several hours of exercise and fun! How did you hear about us? Referred by a friend: Or circle one: Newspaper Google Walk In Previous Participant School My Team
Thanksgiving Week Break Camps 2012 Please List any Allergies and/or Medical Concerns:
What is your child's favorite sport? What sport is your child most interested in trying? Please Read, Sign, and Submit this Form for your child's first day of camp: In consideration of being allowed to participate in any way in the program, related events and activities, and by signing below, I the undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and/or death. 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation. 3. I willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately. 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS GAME ON SPORTS, LLC, its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Parent's Name (Print)_______________________ Signature___________________Date_________
