Summer Camp Detailed Registration Form

BM Youth Camp Registration

Hosted by: Northway Golf Center
Athlete Information
How many Kids?

12Other
Athlete's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender

MaleFemale
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
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Bryan Martin Foundation during the selected camp. In exchange for the acceptance of said child’s candidacy by Bryan Martin Foundation ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Bryan Martin Foundation 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 Bryan Martin Foundation . 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.
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.
Date

MonthDayYear
Date
Signature

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$50 for 1 kid or $90 for 2 kids!

(If more than 2 kids please sumbit another form)

Payment Day Of

OR

Through online payment after sign up
Should be Empty:

BM Youth Camp Registration

Athlete Information