• 2019 Jump With The Stars Registration

  • Participant Information

  • Parent/Guardian Information

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  • Emergency Information

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  • Credit Card
  • Medical release and Indemnity Agreement

    I hereby request that you accept this application for registration in the 2019 Jump with the Stars Workshop of 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 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 possible promotion of the camp.

  • 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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