2025 Fall Summer Camp Registration Form
  • Ron Dickerson Jr. Summer Camp Registration

    Event Date: May 31st, 2025 Event Time: Check-In Begins at 7:00am Event Location: Charlie W. Johnson Stadium Event Address: 1920 Two Notch Rd, Columbia, SC 29204 Grades:  Rising 9-12 & Junior College and Transfers Cost: $50 | Online Registration $60 | Walk-Up Registration *The Ron Dickerson Jr. Football Camp is not responsible for lost or stolen items.* 
  • Athlete Information

  • Parent/Guardian Information

  • Format: (000) 000-0000.
  • Emergency Information

  • Format: (000) 000-0000.
  • Insurance Information

  • Format: (000) 000-0000.
  • Informed Consent and Acknowledgement

    I hereby give my approval for my child’s participation in any and all activities prepared by {RUNTKIDS} during the selected camp. In exchange for the acceptance of said child’s candidacy by  {RUNTKIDS} ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless {RUNTKIDS} . 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  {RUNTKIDS} . 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, including football. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

  • Medical Release and Authorization

    As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

    Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

    Permission is also granted to the  {RUNTKIDS} . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

    Release authorized on the dates and/or duration of the registered season.

    This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

    BENEDICT COLLEGE INFORMATION /WAIVER FORM

    I the above named registrant (the “Camper”) is a participant in the above-referenced camp. The undersigned is the Camper who is eighteen (18) years of age or older or the parent(s)/guardian(s) of the above-named Camper. I (We) know that participation in certain physical activities may result in serious injury or death, and protective equipment does not prevent all injuries. I (We) hereby waive, release, absolve and agree to hold harmless The Corporation of Benedict College, its governing body, administrators, employees, coaches, students and staff as well as the organizers, supervisors, volunteers, sponsors, participants and persons transporting me/the Camper to and from activities (collectively, the “Releasees”), from any claim arising out of any injury to me/the Camper, whether the result of negligence or for any other cause.

    2. I (We) hereby understand that the Camp is organized and operated by a third party independent of Benedict College and that the Camp has contracted with Benedict College to use Benedict College facilities. Benedict College is not operating or overseeing the Camp and is not directly responsible for the Camp program or any Camp activities. I (We) hereby understand that Benedict College is not supervising the Camper and is not directly responsible for the safety or wellbeing of the Camper while the Camper is attending Camp. The third-party individual or entity operating the Camp (Camp Name listed above) is responsible for supervising Camper while Camper is attending Camp.

    3. I (We) have read the foregoing and voluntarily accept and assume all risk of injury, loss of life or damage to property arising from (i) my/the Camper’s participating in activities utilizing Benedict College facilities including its athletic facilities and (ii) my/the Camper’s infection or contraction of COVID-19 or other illness. I (We) hereby waive, release, discharge, covenant not to sue and hold harmless the Releasees from any and all liability related to my/the Camper’s participating in activities utilizing Benedict College facilities including its athletic facilities, COVID-19, and from any claim arising out of any injury to me/the Camper, whether the result of negligence or for any other cause.

    4. I (We) agree to indemnify, defend and hold harmless the Releasees from and against any and all claims, demands, suits, judgments, losses or expenses of any nature whatsoever (including, without limitation, attorneys’ fees, costs and disbursements, whether of in-house or outside counsel and whether or not an action is brought, on appeal or otherwise) arising from or out of, or relating to, directly or indirectly, the infection or contraction of COVID-19 or any other illness or injury as result of utilizing Benedict College facilities including its athletic facilities. It is my/our express intent that this Waiver shall bind any assigns and representatives and shall be deemed as a release, waiver, discharge, covenant not to sue and hold harmless the above named Releasees. This waiver shall be construed, interpreted and controlled according to the laws of the State of South Carolina. I hereby knowingly and voluntarily waive any right to a jury trial of any dispute arising in connection with this waiver.

    5. Accident/medical insurance coverage is not provided by Benedict College. If injured while at Benedict College facilities, I (we) understand that I (we) are responsible for medical expenses and/or insurance coverage.

    6. Property damages and general liability insurance is not provided by Benedict College. I (We) understand that Benedict College is not responsible for property damage resulting from the use of Benedict College facilities including its athletic facilities.

    7. I (WE) FURTHER ACKNOWLEDGE THAT THIS WAIVER WAS EXPRESSLY NEGOTIATED AND IS A MATERIAL INDUCEMENT FOR THE PERMISSION GRANTED BY RELEASEES TO BE ON THE PREMISES AND PARTICIPATE IN THE ACTIVITIES. IN SIGNING THIS AGREEMENT, I (WE) ACKNOWLEDGE AND REPRESENT THAT I (WE) HAVE READ THE FOREGOING WAIVER, UNDERSTAND ITS TERMS AND SIGN IT VOLUNTARILY AS MY (OUR) OWN FREE ACT AND DEED; NO ORAL REPRESENTATIONS, STATEMENTS, OR INDUCEMENTS, APART FROM THE FOREGOING, HAVE BEEN MADE; I (WE) AM FULLY COMPETENT; AND I (WE) EXECUTE THIS WAIVER FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME.

  • 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.

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  • Event Refund Policy 

  • Refunds will ONLY be given when we receive written notice from a physician stating that the athlete is physically unable to participate in the camp. Refund requests will be reviewed by the sports camp administrator and Athletics Office of Compliance for validity. All approved refunds will incur a 15% administration fee which will be deducted from your refund amount.

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        CARD OR CASH APP
        $50.00
          
        CASH FOR WALK UP ($60.00)

        PAYING CASH AT GATE

        $ Free
          
        Total
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        Payment Methods

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