BSO 2019 Sports Weekend Registration Form
When: Saturday-Sunday, Oct. 5-6, 2019

Where: Variety Club Camp, 2950 Potshop Rd., Worcester, PA 19490 (near Valley Forge)

What: This fun weekend will provide fun recreation, sports, & social activities. Come learn and play, plus see old friends and meet new ones. All activities will be conducted by volunteer instructors. On Saturday night, there will be a campfire, marshmallow roasting, and games. Some or all of the following will be offered:

Basketball                    Beep Baseball                   Bowling    
Goalball                       Tandem Biking                        Ping-Pong
Soccer                          Kickball                                    Running
Horseshoes       Tumbling

Who: All blind & VI (ages 9+) who can follow directions, function fairly independently, and
participate in physical activities. No experience necessary. Sighted siblings welcome.
Parents, PE teachers, O&M instructors, Adapted PE & Therapeutic Rec. students, &
other VI professionals are encouraged to volunteer or observe.
Hosted by: Blind Sports Organization (BSO) & Villanova’s Delta Gamma sorority
Overnight Accommodations: Youth will stay in chaperoned cabins. Some housing is
available for adults and parents in single-sex, camp-style cabins; but there are also motels
nearby. Sat. lunch & dinner, Sun. breakfast & lunch, and snacks/drinks are provided.

To Register: Complete the form below or call (610) 931-0911.

Cost:

Participants 18 and UNDER

     BSO Member: FREE
     Non-BSO Member: $8.00

Participants 19 and OVER

    BSO Member: $25.00
    Non - BSO Member: $35.00

(includes lodging & 4 meals).

Note: Partial (need-based) Scholarships are available upon written request.
Registration deadline is Sept. 21st. Confirmation with directions, transportation info. &
what to bring will be sent.

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Name *
Enter child's name here if participant is a minor
Phone Number *
Address *
City *
State *
Zip Code *
E-Mail Address *
Age
Please check all that apply: *
Required
Do you plan to stay overnight? *
Name of Emergency Contact #1 *
Phone Number of Emergency Contact #1 *
Name of Emergency Contact #2 *
Phone Number of Emergency Contact #2 *
Participant Vision Classification
Clear selection
BSO Membership Status *
USABA Membership Status *
I understand that no registration is considered complete until payment has been received. Payments may be submitted through the Sports Weekend page on BSO's website: www.blindsports.org *
WAIVER, RELEASE, and HOLD HARMLESS AGREEMENT *
In consideration for being allowed to participate in the Blind Sports Organization’s Mid-Atlantic Sports Weekend, October 5-6, 2019 at the Variety Club Camp & Developmental Center; I hereby waive, release, and discharge Variety Club, BSO, and the Delta Gamma Sorority, including their employees, agents, servants, and instrumentalities from any and all liabilities, causes of action, rights or claims for death, disability, personal injury, property damage, or theft, which may accrue to me as a result of my participation in these events.  I also understand that I may be held liable for any damage or loss to the facilities caused by my actions.  I will indemnify and hold harmless: BSO, its officers and volunteers; Variety Club and their employees, agents, servants, and instrumentalities, and Delta Gamma sorority from any liabilities, claims, causes of action of any kind, and claims made by other individuals or entities, which may result from any of my actions during my participation in these events.                                                                                                                                                                                                                                                                                                                                                                                                                                   By typing your name below you agree to and accept the Waiver, Release, and Hold Harmless agreement described above.
Photography Release
I give permission for my child and myself, to be photographed for education, BSO promotion, or publicity purposes.  I understand that the pictures may be used in BSO’s newsletters, brochures, press articles, and other publications, as well as on the organization’s website.  Names may appear in the caption.  No contact information will be provided without my express permission.                                                                                                                                                                                                                                                                                                                                                                                                                               By typing your name below you agree to and accept the Photography release described above.
Additional Comments?
Please provide any additional details you'd like us to know about! Dietary Restrictions? Bringing family or friend?
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