* Camper's Name:
* Please fill out a separate form for each child.
Mailing Address:
City: State: ZIP Code:
Child's Home Telephone Number:
Child's Age:
Child's Gender:
My student will participate in (please indicate 1st and 2nd choice of activity):
Basketball
Cheerleading
Football
Soccer
Volleyball
Other
Camper's T-shirt Size:
Camp cost is $20 for the first child and $15 for each additional. Add $5 for a camp group photo if you'd like. Please send total payment to Ancient Path, PO Box 418, Windsor, CO 80550.
Please note that you will have to sign a Photography Release, which includes the following information: By signing up for camp, I give the Ancient Path Sports Camp permission to use audio, video or photography of my child for promotional purposes. I understand that there will be no photos of my child posted on the Internet.
Medical Release
I, the undersigned parent/guardian, do hereby grant permission for my son/daughter, to attend the clinic. In order that my son/daughter may receive the proper medical treatment in the event that he/she may sustain injury or illness during the period of the clinic, I hereby authorize the clinic staff to obtain or provide medical treatment for my son/daughter for such injury or illness during the clinic, and I hereby hold the clinic staff and sponsoring organization(s), as well as it's representatives, harmless in the exercise of this authority.
I further understand that there is always a possibility that my son/daughter may sustain physical illness or injury while at the clinic. If this occurs, I hereby authorize the clinic staff and representatives to refer my son/daughter to a medical treatment center (hospital, etc.). I further acknowledge and understand that I will be responsible for any medical bills that may be incurred on behalf of my son/daughter for physical illness or injury that he/she may sustain during the clinic.
Understanding that there is always a possibility that my son/daughter may sustain physical illness or injury, I acknowledge and understand that my son/daughter is assuming the risk of such physical illness or injury by his/her participation, and I further release the sponsoring organization(s) and its representatives from any claims for personal illness or injury that my son/daughter may sustain during the clinic. I further acknowledge and understand that my son/daughter will be responsible for his/her failure to abide by the rules and regulations of the clinic.
Parent / Guardian:
Home Phone: Other Phone:
Allergies/Health Conditions:
Medication Needed:
Other emergency contact and people authorized to pick-up my child: (Your student will ONLY be released to the guardians on this list.)
Person 1:
Person 2:
Person 3:
Person 4:
Please note that you will have to sign the Medical Release form.
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