Summer Camp Registration

XTREME
Texas Xtreme Sports Summer Camps
Child Information
Name
Address
City
State
Zip
Date of Birth

MonthDayYear
Date
Sex
Age
School Attending
Grade
Parent/Guardian Information
Mother's Name
Phone Number
Email Address
example@example.com
Father's Name
Phone Number
Email Address
example@example.com
Please check below the week that your child will be attending Summer Camp, check all that apply*

June 2-4June 9-11June 16-18July 14-16July 28-30
Emergency Contact Information
Name
Relationship
Phone Number
Only the individuals listed above are authorized to pick up my child or be contacted in case of emergency unless otherwise advised by a guardian.
List below your drop in date(s) - Each drop in day is $60
Payment Policy
Once you have completed the registration packet, we will email you a link to pay for the camp. The fee must be paid in full prior to the first day of the camp. If you sign up for the extended day we will add that fee into the total.
Texas Xtreme Sports Media Release
Please be advised that while at the gym your child may be photographed/videotaped during various gym activities. With your consent, the photograph or video may be reproduced and released for use in the media, for example newspapers, brochures, flyers, videos, our gym website and various social media platforms such as Facebook, Instagram, and Snapchat.

Please indicate your preference below:
Athlete Name
Athlete Name

My child's photograph/video MAY be reproduced and released for use in the media.My child's photograph/video MAY NOT be reproduced and released for use in the media and therefore will be not included in pictures/videos.
Parent Signature

Clear
Date

MonthDayYear
Date
Texas Xtreme Sports Medical Release Waiver
Student's Name
I/We the parents of the named student participate in cheerleading, tumbling, gymnastics, or other physical activities while a student at Texas Xtreme. By granting permission for said student to participate at Texas Xtreme Sports, I/We assume full responsibility for said student's personal safety and release Texas Xtreme Sports and its employees from any and all liabilities that may arise due to any injury including death to said student's participation in any activity at Texas Xtreme Sports, or which Texas Xtreme Sports is participating at elsewhere.
I/We understand that there is personal risk involved in any physical activity that involves motion, height, or rotation and that these activities can result in serious injury, disability, and/or death.
Initial Here
I/We the parents of the named student participate in cheerleading, tumbling, gymnastics, or other physical activities while a student at Texas Xtreme Sports. By granting permission for said student to participate at Texas Xtreme Sports, I/We assume full responsibility for said student's personal safety and release Texas Xtreme Sports and its employees from any and all liabilities that may arise due to any injury including death to said student's participation in any activity at Texas Xtreme Sports, or which Texas Xtreme Sports is participating at elsewhere.
Initial Here
I certify that the above listed student is physically able to fulfill the requirements to be a student at Texas Xtreme Sports. I understand that this form legally releases all obligations and responsibilities for medical treatment of my son/daughter in event of illness or injury during any activity when either parent can not be reached. If there is any physical or medical reason why he/she should not participate fully, Texas Xtreme Sports requires a doctor's release. Furthermore, Texas Xtreme Sports is not liable for any injury incurred during physical activity.
Initial Here
Parent Signature

Clear
Date

MonthDayYear
Date
Medical Treatment Permission Form
Medical Treatment Permission Form

In the case of an emergency occurring while my son/daughter is at Texas Xtreme Sports, in a class, at practice, or a competition. I grant permission to Texas Xtreme Sports and its employees to take whatever action is necessary. In the event that I can not be reached, I hereby authorize Texas Xtreme Sports and its employees to give consent for my child to receive medical treatment.
Initial Here
Parent Name
Cell Phone #1
Cell Phone #2
Home Address
City
State
Zip Code
Doctor
Phone Number
Insurance Company
Policy #
If you do not give us permission or authorization for consent for medical treatment, what procedures would you like us to follow?
Check any and all that apply

Heart ConditionDiabetesAsthmaConvulsions Disorder
Are your child's vaccination records up to date?

YesNo
Any Allergies to Food or other allergens?

YesNo
If yes, please list
Any Allergies to Medication?

YesNo
If yes, please list
Additional Medical Information we should know?
Parent Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

XTREME

Texas Xtreme Sports Summer Camps

Child Information

Parent/Guardian Information

Emergency Contact Information

Payment Policy

Texas Xtreme Sports Media Release

Texas Xtreme Sports Medical Release Waiver

Medical Treatment Permission Form