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Registration Form, Release, and Conduct
Code
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Please print form, complete,
sign and mail to:
Olympic Peaks
Cross Country Camp, P.O. Box 4471, Rolling Bay, Wash. 98061
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| Name: |
Week attending: July 26-31 |
| Home Phone: |
Email address: |
| Grade (Fall, 2008)
Sr. Jr. So. Fr. |
School: |
| Emergency Contact: |
Emergency Phone: |
| Age: |
Gender:
M F |
Date of Birth: |
T-shirt size:
S M L XL |
| Do you have any special food needs or
allergies? |
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I,_______________________________ (Parent/Guardian), hereby grant permission
for my child, ________________, to attend the Olympic Peaks Cross Country Camp
and verify that my child has received a physical examination in the past year
and is physically capable to participate in activities, some of which are
physically vigorous, related to the camp. I understand that participation in a
running camp, despite all reasonable precautions implemented for my child’s
safety, caries a risk of injury.
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Consequently, I hereby, for myself, my child, heirs, executives and
administrators, do waive and release any and all rights against all persons
given responsibility by the Olympic Peaks Cross Country Camp for the conduct of
activities and rendering of services to my child in association with our
participation. I hereby authorize the staff of the Olympic Peaks Cross Country
Camp to act for me according to their best judgment in any emergency requiring
medical attention and waive and release all involved from any and all
liabilities for any injuries or illness incurred by my child during his/her
involvement at this camp. I have no knowledge of any impairments that would
limit or preclude my child’s involvement in any activities commonly associated
with this type of instructional camp. I agree that costs for treatment of
injuries or hospitalization for illness or injuries incurred during the camp
will be the responsibility of the parent or guardian of the camp participant. I
agree that any insurance carried by the parent or guardian may be used to defray
such medical and hospital costs.
I understand the refund policy states that A $50.00 fee will be charged
for processing a cancellation prior to June 1. A $100 refund will be
offered for cancellations between June 1 and July 1. There will be no
refunds given after July 1.
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Parent/Guardian signature:
Date:
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Please Provide Insurance Information
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Ins. Co.
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Subscriber’s Name
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Policy No.
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At a minimum, each participant is expected
to: |
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I hereby acknowledge that I will observe all camp rules as listed and told to me
and accept that in case of noncompliance, I will be subject to immediate
dismissal. I agree to provide for my own transportation arrangements should I be
dismissed from the camp. I further recognize that my parents/guardians or myself
will be held financially and legally responsible for any damage caused by me to
the camp and/or its property or facilities. |
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