Cobb PAL Martial Arts Skills Camp Registration Form
Please complete the form below.
Participating Child's Name
*
Prefix
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
Age
*
Parent/Guardian Name
*
Prefix
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Does child receive free or reduced lunch at school?
Yes
No
I agree to allow Cobb PAL to use any photographic image of my child taken while participating in the Cobb PAL Martial Arts Skills Camp. These images may be used in promotions or marketing materials.
*
Yes
No
I, the parent and or/legal guardian of the above named son/daughter hereby grant permission for his/her participation in the activities of the Cobb PAL Martial Arts Skills Camp and their related activities. On Behalf of my son/daughter and myself, I acknowledge that he/she will be using facilities at his/her own risk and I, on my own behalf, hereby release, discharge and indemnify Cobb PAL from all liability for injury to person of damage to entrant. I further understand this release applies to transportation to and from all practices. You are authorized on my behalf and at my account to take measures and arrange such medical and/or hospital treatment, as you may deem advisable for the well being of my son/daughter.
*
Yes
No
Save
Submit Form
Should be Empty: