Holiday 2023 Camp Registration

Holiday 2023 Camp Registration
Dates:
- Week 1: December 18th to December 22nd, 2023
- Week 2: December 27th to December 29th, 2023
- Week 3: January 2nd to January 5th, 2024
Venue: BFA Field

Cost:
- Week 1: $200 per week (without kit) or $250 per week (includes kit)
- Week 2: $120
- Week 3: $200
Aftercare: $10 per day
Note: Completing this form indicates your request for camp admission. Upon receiving the form, the DaRockElite Performance team will be in touch to confirm your request and provide payment details. Your child's spot in camp is not guaranteed until payment is received.
Participant's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Participant Age:*
Gender of Participant:*

MaleFemalePrefer Not to Say
Allergies?:
Food, Asthma, Etc?
Parent/Guardian Name:*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contact Name (Different than main contact name):*

First NameLast Name
Emergency Contact Phone Number (Different than main contact number):*
Please enter a valid phone number.
Which package do you want to sign your athlete up for?*

Week 1 Package - No Kit ($200)Week 1 Package - Kit Included ($250)Week 2 PackageWeek 3 Package
Which week(s) do you want to sign your athlete up for?*

Daily: Email to select which daysWeek 1: July 3rd - 7thWeek 2: July 10th - 14thWeek 3: July 17th - 21stWeek 4: July 24th - 28thWeek 5: July 31st - August 2nd (Cupmatch Week)Week 6: August 7th - 11thWeek 7: August 14th - 18thWeek 8: August 21st - 25thWeek 9: August 28th - September 1stWeek 10: September 4th - 8th
Camp is from 9 AM - 4 PM. Aftercare is available until 5 PM for $10 daily. Would you like to add on aftercare?*

YesNo
Camp Kit Size

Youth SmallYouth MediumYouth LargeYouth X LargeMen’s SmallMen’s MediumCamp Jacket (Additional $50)
COVID-19 Protocols
- Participants will have their temperature taken/recorded daily. If it exceeds 37.5°C (99.5°F), they will be asked to seek medical advice and will not be allowed to participate in camp.
- Hand sanitizer will be available and participants will be encouraged to use it frequently.
- Participants and/or a member of their household must not be under travel-related quarantine.
- Participants/Guardians of Participants agree they have not been exposed to an individual demonstrating COVID-19 symptoms, and are not under public health ordinance to be quarantined.
- Participants/Guardians of Participants agree that they are not currently showing symptoms of COVID-19.
- Participants/Guardians of Participants agree to inform management if someone in their household (or a close contact) tests COVID-19 positive or is in quarantine.
Date

MonthDayYear
Date
Waiver

By signing this form, you acknowledge you and/or your child participate voluntarily in sports activity, recognizing any affiliated risks with such. You hereby indemnify and hold harmless Danté Leverock, DaRock Elite Performance, Life through Sport (including the supervisors, sponsors and officers) against all claims, demands, losses, expenses (including all legal expenses) or damages caused by you and/or your child’s voluntary participation in sports activity. You agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect you and/or your child’s ability to participate in said fitness program.

You hereby consent and grant Danté Leverock and DaRock Elite Performance, for an indefinite term, the authority to photograph or record you and/or your child and to use you and/or your child’s likeness, image, sound, recording, performance or any portion thereof (together, the “Performance”) or name throughout the world in any medium, including, but not limited to any reproduction, recording, portrayal, publication, copying, modification, performance, distribution or display of my name, image, likeness, voice, speech and other personal characteristics in any manner, form, format or media whatsoever (“Media”) for any purpose relating in any way to the publication, display, advertising, marketing or promotion of whatsoever purpose. You also acknowledge and agree that you will not have the right to review the Media or Performance before publication or distribution.
Signature:*

Clear
Print Name of Person Filling out Form:*

First NameLast Name
Date:*

DayMonthYear
Date
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