Camp Registration Form-2019 Winter

Winter 2019 Pre-Competitive Fencing Camp Registration

PDX Fencing Winter 2019 Pre-Competitive Camp Dec. 26-27, 2019

Enroll my child in the Dec.26-27, 2019 Camp. Camp runs from 9:00 a.m to 12 noon.

Participant Name: Last, First

Camper has no known allergies or medical conditions EXCEPT as known here (describe allegens, conditions, severity of reactions, treatment)

Your First & Last Name: Parent/LegalGuardian

Email and telephone number:

Emergency Contact during Camp: Name and phone number(s)

LIABILITY WAIVER & CONSENT : I am the parent and/or legal guardian of the participant named above. I hereby give consent for him/her to participate in fencing instruction, bouting, games, physical fitness and any camp activities. I recognize and agree that participation in this camp and related activities includes strenuous physical activity and/or activities that may be potentially hazardous. I/we hereby accept the risks, waive and release all liability and all claims against PDX Fencing, its coaches, staff, agents, and volunteers for any injury or death to participant caused by accident or negligence. CONSENT FOR MEDICAL TREATMENT: This is to certify that I give my written consent to PDX FENCING and it's representatives to obtain medical care from any licensed physician, athletic trainer, hospital, clinic, paramedics, for any injury or illness that may arise during the fencing camp or while on the PDX Fencing premises. I understand that attempts to reach the emergency contacts I listed in this form will be made immediately.

Payment: Club Members: $125.00. Pre-pay in full by Nov. 26 and save $25.00. Payment can be mailed in or paid while in the club. You can also pay online using the Zelle app. VISA/MC/DISCOVER/ZELLE. . If using Zelle for the first time to pay us, let us know so we can give you the correct cell phone number to pay to.