Angels Academy Spring Break Camp Sign Up 2020
Spring Break Camp: March 16-19
Email address *
Child Name *
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Age *
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Which Camp- check all that apply *
Required
2nd Child Name
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Age
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Which Camp- check all that apply
3rd Child Name
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Age
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Which Camp- check all that apply
4th Child Name
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Age
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Which Camp- check all that apply
Parent/Guardian Names *
Your answer
Cell Phone # *
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Email Address *
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Home address-- City, State, Zip *
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Emergency Contact and Phone *
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Any Allergies or Inhalers- If yes, please explain *
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Additional Comments
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Release Statement
I, the undersigned, to induce the Wichita Angels (WA) and Angels Academy (AA) and any or all instructors conducting practices/activities, hereby give my consent and agree to release, indemnify, and hold harmless AA & WA from all damages for any claim arising out of any injury, physical or mental, to or loss of life by any participant, in any way related to any participants presence at or participation in AA & WA facilities or activities, including, without limitation any complications to such injuries caused/aggravated by any participants pre-injury state of health or refusal to obtain medical treatment based on any personal beliefs or otherwise. Furthermore, I hereby authorize personnel associated with AA & WA, as my agents, to take actions, to consent to medical/surgical exams/treatment as may be required in emergencies to preserve the physical well-being of any participant; provided prudent efforts have been made to contact any listed legal guardian to notify the same of the situation. I also consent to allow pictures or video of my child’s classes to be used in media promotions for Angels Academy and the Wichita Angels.
Signature Acceptance
I understand that typing my name below constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
Signature *
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Payment Link
Please don't forget to visit www.wichitaangels.com and Summer Camps to send payment via credit card or paypal. Or send money through paypal directly to coachdave@wichitaangels.com. Or pay with cash at the door!
A copy of your responses will be emailed to the address you provided.
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