SUMMER CAMP 2024 REGISTRATION
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Last Name *
Student First Name *
Gender *
Birthday *
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DD
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YYYY
Age *
Any medical condition or allergies: *
Parent Name *
Phone Number *
Address *
E-mail *
Emergency Contact (when the parent cannot be reached) (Name / Phone number) *
Date *
Required
Consent *
I acknowledge that the 2024 Arts, science, multi sports Summer Camp has in it components of  athletic events and this could be  a test of a person’s physical and mental limits and carries with it the potential for injury or hurt. I hereby assume all of the risks of participating in this event. I certify that I am physically fit and have not been advised otherwise by a qualified medical person not to participate in physical/sporting activities. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, release, and discharge from any and all liability from this event, staff volunteers ,  employees and volunteers of Coach John Leadership & Community Engagement, (B) indemnify and hold harmless all entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of my actions during this event. I understand that at this event or related activities I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, sponsors, affiliate or organizers. This AWRL shall be construed broadly to provide a release and waiver to the maximum extent permissible under the applicable law. I hereby certify that I have read this document and I understand its content.
PAYMENT INSTRUCTION & CANCELLATION POLICY *
 Summer Camp   $100/week Cancellation policy is 25% of fees if done before camp starts first week of July and 50% when camp has   begun (after July 4th).
Do make payment by  ETRANSFER TO : coachjohnacademy@gmail.com

once the spots are filled the link will stop accepting new registration, as long as the link is accepting registration do go ahead by filling the form and then making payment to complete your registration. NOTE: Registration is completed only after payment made. An email will be sent to you once payment is received.
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