Parent/Guardian Registrant Information

Name

Phone Number

Address

The More Weeks You Book, The More You Save!

2 Weeks = 10% off, 3 Weeks = 15% off and 4 Weeks = 20% off!

Sign up 2 or more campers (up to 5) to receive an additional 10% off! - As you add campers and weeks, your savings are automatically calculated.

Please note: To add additional campers, save registrant, then choose "add another registrant". The parent/guardian must add themselves as a registrant for each camper signed up.

Camper Name

Program

(Check off multiple weeks to calculate your savings.)

Date of Birth

Allergy, Health Concerns Any additional supports we should know about (e.g. academic, social, emotional)

Grade Completed

Current School

Health Card Number

Total

$0.00

Terms & Agreements

This form is to be read and electronically signed by every parent/guardian of a child who registers for Westside FUNdamentals.

ELEMENTS OF RISK:

I/We the undersigned hereby acknowledge that certain risks of injury are inherent to participation in sports and recreational activities. These types of injuries may result from the nature of the activity and can occur without any fault of the participant or Westside FUNdamentals, its employees/agents or the facility where the activity is taking place.

I/We understand that the rules and regulations set out by Westside FUNdamentals are designed to promote a positive experience and provide a safe and secure environment for the participants and hereby undertake to abide by these rules and regulations.

LIABILITY:

Westside FUNdamentals does not provide accidental death, dismemberment or medical insurance on behalf of the children participating in the program.

I/We hereby warrant that our registering child/children is/are physically fit to participate in this program and that the choice to participate brings with it the assumption of risks for any injury that may occur.

ACKNOWLEDGEMENT:

I/We have read and fully understand this Informed Consent Agreement and hereby consent to having the child/children named below participate in Westside FUNdamentals, acknowledging that the undersigned is assuming the risks associated with doing so.

I have read and agree to the terms above.

Coupon Code

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Name

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