2024 Jump With The Stars Registration Form

2024 Jump With The Stars Registration Form Comet Skippers

Workshop staff will teach all levels of jump rope skills, from the very basic to advanced. Children and adults are all welcome to attend. We will cover skills and routine development in single rope, Double Dutch, Chinese wheel, long rope and fusion.
Participant Information
Partipant Name*

First NameLast Name
Please select Team or school name from the dropdown list. If your Team/school is not listed, please select "other" and fill in the box below.
If you selected "other" from the list above, please use this space to let us know your Team name or what school you attend.
Grade*
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Jumper Experience Level*

Basic (Little or no experience)ElementaryIntermediateAdvanced
T-Shirt Size (One t-shirt included for participants registered by 11/11/24)
Parent/Guardian Information
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Emergency Information - (If parent/guardian is unavailable)
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Registrations received from November 12th onward will be $80.00, and are not guaranteed a t-shirt, but will receive one if available. Lunch may be added on for an additional $10.00, please see options below. The addition of lunch is not available after 11/28/24.

Please select from the below workshop options:

Workshop Participant $70.00

Registrations received from November 12th onward will be $80.00, and are not guaranteed a t-shirt, but will receive one if available. There will be no refunds after November 25th.

Additional T-Shirts (only available through 11/11/24)$15.00

(Remember one is included with your full day registration)

Size:	Quantity
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL

Subway Lunch (only available through 11/28/24)$10.00

(Lunch may be added on for an additional $10.00, please see options below. The addition of lunch is not available after11/28/24. Lunch includes a 6" sandwich, chips, fruit, cookie and a bottled water)

SandwichCheese

Jump rope add-on$10.00

You may choose to add a beaded ($10) and/or licorice ($5) rope to your registration. Ropes will be picked up the morning of the workshop.

Jump Rope options

Private Lessons - Friday Evening (Offered for Individuals, Pairs, Wheel, DD3, or DD4)$24.00

Please list the name(s) of your pairs, wheel, DD3 or DD4 partners in the text box below.

	Quantity	Price
Individual		$24.00
Pairs		$12.00
Wheel		$12.00
DD3's		$8.00
DD4's		$6.00

Item subtotal:$0.00

Elite Sunday Session Participant (by invitation/coach recommendation only) $30.00

$30.00 Sunday Elite Workshop fee by 11/11/24 $40.00 Sunday Elite Workshop fee after 11/11/24

Has your coach signed off on your participation in the Elite workshop?

Total $0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please list name(s) of your pairs, wheel, DD3, DD4, or fusion partners here if scheduling Private Lessons:
Medical release and Indemnity Agreement

I hereby request that you accept this application for registration in the Comet Skippers Jump with the Stars Workshop for myself (if age 18+) or my child named above, and in consideration of your acceptance of this application, I hereby release Comet Skippers Inc., Mason City Schools, and all of its facilities and employees and all persons associated with the Comet Skippers Jump with the Stars Workshop, of and from all claims or causes of injury to the participant arising from participation in the event, whether such injury is a result of negligence or some other cause. If medical attention is required for injury or illness while at the Comet Skippers Jump with the Stars Workshop, I give permission for such medical care and will be financially responsible. I also give permission for photography and or video to be taken and used in the future for promotional purposes.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
I Agree
Signature:*
Should be Empty:

2024 Jump With The Stars Registration Form Comet Skippers