Camp of Champions A & M Summer Camp Registration
Camp of Champions A & M Summer Camps - July 17 - 21, 2017
Camp Site: Desert Chapel High School Campus, 630 South Sunrise Way, Palm Springs, CA
Telephone: (760) 660-3372
Summer Camp Selection
You may select one or more Summer Camp options.
I am registering for: *
Participant's Information
Camper Name *
Your answer
Date of Birth *
Your answer
Parent/Guardian Information
Parent/Guardian Name: *
Your answer
Parent/Guardian Address: *
Your answer
Parent/Guardian Email Address: *
Your answer
Parent/Guardian Cell Phone Number: *
Your answer
Emergency Contact Information
Emergency Contact Name & Relation to Child *
Your answer
Emergency Contact Cell Phone Number *
Your answer
Please list any allergies. *
Your answer
Accident Waiver & Release of Liability Form
I hereby assume all of the risks of participating in these Summer Camps, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

I certify that I am physically fit and have not been advised to not participate by a qualified medical professional. I certify that there are not health-related reasons or problems which preclude my participation in these Summer Camps. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the organizers of the Summer Camps in which I may participate and that it will govern my actions and responsibilities at said Summer Camps.

In consideration of my application and permitting me to participate in these Summer Camps, 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 but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from these Summer Camps. The following entities or persons: Camp of Champions A & M, Desert Chapel School, Timothy Ingram, and/or their coaches, agents, representatives, or volunteers.

B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in these Summer Camps, whether caused by negligence or otherwise.

I acknowledge that these Summer Camps my carry with it the potential for death, serious injury, and personal loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, and lack of hydration.

I consent and agree that Camp of Champions A & M, Inc. , and/or their coaches, agents, representatives, or volunteers may take photographs or digital recordings of me as a participant during the Summer Camps and use these in any and all media for training and promotional purposes. I further consent that my identity may be revealed therein or by description text or commentary. I waive any rights, claims, or interest and I understand that there will be no financial remuneration.

The Accident Waiver, Release of Liability, and Image Release shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND FULLY UNDERSTAND ITS CONTENTS. I am aware that this is a Release of Liability and a contract and I sign it on my own free will.

Print Participant's Name & Age *
Your answer
Signature & Date (If under 18 years old, a Parent/Guardian must sign): *
Your answer
Parent/Guardian Waiver for Minors (Under 18 years old)
The undersigned parent and/or natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward's participation in the Summer Camps, and has agreed individually and on behalf of the child or ward, to the terms of the Accident Waiver and Release of Liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.
Print Participant's Name & Age
Your answer
Parent/Guardian Signature & Date
Your answer
Method of Payment
* Payment may be made at the time of sign in for camp.
* Payment may be dropped off to the Desert Chapel High School office (630 S. Sunrise Way, Palm Springs).
* Checks can be mailed to Camp of Champions A & M, 64477 Spyglass Ave., Desert Hot Springs, CA 92240.
* Credit Card payments can be processed by calling 760-660-3372.
I will pay the Registration Fee(s) with : *
I understand that I will have to pay the Registration Fee(s) prior to, or at the time of, sign in for camp. *
Additional Comments or Information:
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