KIDS SPORTS ZONE – February Break CAMP 16-20 & Monday 23^rd

Camp is for kids ages 2-6 years of age. And will be divided up into appropriate groups.

TIME OPTIONS ARE 8:30-12 ($35)  8:30-2 ($50)  

PLEASE CIRCTLE DAY(S) AND WRITE IN TIMES. or  EMAIL TO SIGN UP & PAY KidsSportsZone@gmail.com

Monday     Tuesday     Wednesday    Thursday     Friday       Monday (23^rd)

_______     _______      ________     ________   ________   _________

Kids Sports Zone Waiver

Name of Participant: _____________________________________DOB: __________      M/F

Contact Information for Participant

Parent  -First Name/Last Name: _____________________________Email Address:__________________

Address: _______________________________________Town/City: __________________________  Home Phone: __________________________Cell Phone or Best Number to be reached: ____________

Emergency Contact

First Contact Name: _________________________________  Relationship: ____________________

Number:___________________________

Second Contact Name: _______________________________ Relationship: _____________________

Number:____________________________________

Please list any allergies, medications, or special health considerations we should be aware of:___________________________________________________________________________________

Waiver of Participant by parent or self: In consideration of your accepting my or my child’s registration and entry, I hereby for myself,my child, my heirs, executors and administrators, waive and release any and all rights and claims for damages I or my child may have against  Integrated Sports Training, Growing Tree Yoga, or Sara Holland; and its representatives, successors and assigns, for any and all injuries suffered by myself or my child at the activity sponsored by these groups. I understand there is inherent risk associated with the(se) activity(ies) and authorize emergency medical treatment and transportation in my absence. If any of the above participants are minors, I certify by my signature that I am the custodial parent or guardian; or I have the expressed authorization of the custodial parent, or guardian to enroll said participant(s) in the specified activities listed.

SIGNATURE OF PARENT/GUARDIAN  DATE _________________________________________

KidsSportsZone@gmail.com