Camp Registration - Summer 2021 Beginners Camp - Session 3

Summer 2021 Beginners Camp Session 3 Aug. 02 - 06, 2021 9 a.m - 11:55 a.m

Enroll my child in the Session 3 Summer Beginners Camp Aug 02 – 06, 2021 camp Camp runs Mon – Fri from 9 a.m – 11:55 a.m

Participant Name: Last

Participant Name: First

Participant age

Male or Female

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

Telephone number Including. area code:

Street Address

City

State

Zip Code

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

LIABILITY WAIVER & CONSENT : I am the parent and/or legal guardian/adult participant of the participant named above. I hereby give consent for him/her to participate in fencing instruction, bouting, games, physical fitness, field trips 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: $150.00. Non members $175.00. Pay 30 days in advance and save $25.00 when you register. Payment can be mailed in or paid while in the club. You can also pay online using the free Zelle app. or Venmo apps. VISA/MC/DISCOVER accept in the club or online. By mail to: PDX Fencing, 5645 S.W. Arctic Drive. If you want an online invoice sent to you that you can pay with your credit card on line fill in your email address below. Paying in full 30 days prior gives you a $25.00 early pay discount.

Payment

ZELLE (pay to email: office@pdxfencing.com) VENMO (pay to @PDXFencing) Mail in check (PDX Fencing 5645 SW Arctic Drive Beaverton OR 97005) VISA/MC/Discover - send me an invoice that I can pay online VISA/MC/Discover - I will phone in my card or come in with payment