Synergy 2025 Kids Summer Camp Registration Form

Synergy Kids Camp Registration

2025
Athlete Information
Kids Camp Week

July 7 -July 11 (Hockey Week)July 14 - July 18July 21 - July 25 (Hockey Week)July 28 - Aug 1Aug 4 - Aug 8 (Hockey Week)Aug 11 - Aug 15Aug 18 - Aug 22 (Hockey Week)Aug 25 - Aug 29
Athlete's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
T-Shirt Size

Youth SmallYouth MediumYouth LargeAdult SmallAdult Medium
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the athlete prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Synergy Fitness and Nutrition during the selected camp. In exchange for the acceptance of said child’s candidacy by Synergy Fitness and Nutrition, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Synergy Fitness and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Synergy Fitness and Nutrition . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
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.
Signature

Clear
Method of Payment (* Payment must be made in full to hold camp spot)

E-Transfer to nick@synergyfitnut.comPay in person at SynergyMindbody Payment
Should be Empty:

Synergy Kids Camp Registration