MARCH BREAK CAMP 
REGISTRATION FORM
Sign in to Google to save your progress. Learn more
Email *
FIRST NAME *
LAST NAME *
GENDER *
BIRTHDAY *
MM
/
DD
/
YYYY
Any medical condition or allergies: *
PARENTS NAME *
PARENTS ADDRESS *
PHONE NUMBER *
EMERGENCY CONTACT NAME *
EMERGENCY CONTACT PHONE NUMBER *
I acknowledge that the march break camp has component of sports , recreation, arts and craft and leadership training program and the sports component could also be light  test of a person’s physical and mental limits and carries with it the potential for injury or hurt in its sports component. 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 sporting activities. In consideration of my application and permitting me to participate in this program, 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, Coach John Leadership & Community Engagement Initiative ,  employees and volunteers, (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.  *
I CONSENT *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy