Path to Victory Leadership Clinic at Christ Lutheran Church in Pewaukee (Saturday, Aug. 21, 9:30a.m. - 12:30p.m.)
One form for EACH child. Please use upper and lower case letters.
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Email *
Child's First Name *
Child's Last Name *
Gender *
Grade for 2021-2022 School Year *
Address *
City *
Mom's Name & Mobile Number
Dad's Name & Mobile Number
Other Contact Person's Name and Number (during clinic hours) *
(Mom & Dad would be called first)
Medical Concerns - Physical limitations, conditions, allergies, etc. *
Home Church Name *
How did you hear about the clinic? *
Permission & Waiver
The child named above desires to participate in the Path to Victory Camp, located on the property of Christ Lutheran Church.  The undersigned parent/guardian acknowledges that there are dangers and risks of injury inherent in sports activities, but still allows his/her child to participate in said activities.  THEREFORE, the undersigned, for and in consideration of the opportunity to participate in the Path to Victory Camp and for other good and valuable consideration, does hereby accept full responsibility for liability and cost of treatment of injury to the above registered person.  The undersigned does hereby release the teachers, coaches, assistants, Christ Lutheran Church, Path to Victory, and affiliates from all liability resulting from negligence and agrees to hold them harmless for any injuries and/or damages his/her child may sustain arising out of the activities inherent in a sports camp.  In addition, the undersigned gives Path to Victory permission to photograph the child named above and to use those photos in print publications and websites (name tags with first names may be visible).The undersigned further declares and represents that no promise, inducement or agreement not herein expressed has been made to the undersigned, and that this release contains the entire agreement between the parties hereto, and that the terms of this release are contractual in nature and are not a mere recital.

By entering my full name below, I am stating that I have read and understood the above statement, and that I agree with its terms. I also understand that entering my name constitutes a legally-binding signature.
Your First & Last Name *
A copy of your responses will be emailed to the address you provided.
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