Summer Camp Detailed Registration Form

2026 Watersports Summer Camp Registration Form
We are excited to open early registration to our returning campers for our 4th annual Watersports Summer Camp June 1st-4th and June 15th-18th! Drop off is at 8am and pick up at 2pm (Fort Maurepas, 499 Front Beach Drive, Ocean Springs). Please bring sunblock, a hat, water shoes, a water bottle and a sack lunch each day. This will be an extremely focused and unique watersports experience! We will be adding some wakeboarding and sailing this year! If you have any questions or concerns, please do not hesitate to call or email me:(228-990-2995) bendingpines@gmail.com
Which camp will your child be attending?

June 1-4June 15-18
Camper Name

First NameLast Name
Birth Date

MonthDayYear
Age
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

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

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the camper have any Watersports Experience?

Can swim but it has been a whileModerate swimmer and has tried watersports beforeStrong swimmer and has lots of watersports experience
Does the camper have any allergies, chronic illness, or medical conditions? Any dietary needs or restricions? If yes, please describe.
The camper will be dropped off at 8am and picked up at 2pm at Fort Maurepas City Park (499 Front Beach Drive, Ocean Springs, MS). Who will be picking up the camper?
Is it okay if we take photos/videos of your child during the camp?

YesNo
Is this your first year camp?

YesNo
What size shirt does your child wear?

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XL
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by {Bending Pines Watersports LLC} during the selected camp. In exchange for the acceptance of said child’s candidacy by {Bending Pines Watersports LLC} ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless {Bending Pines Watersports LLC} . 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 {Bending Pines Watersports LLC} . 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 basketball. 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 {Bending Pines Watersports LLC} . 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.
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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My Products

Deposit for June 1-4 (Hold Your Spot)We require a 50% non-refundable deposit that secures your child's space for the June 1-4 camp. Rain, shine or emergency, this deposit is nonrefundable. The remaining balance of $300 will be paid in person on the first day of the camp.

$300.00

Deposit for June 15-18We require a 50% non-refundable deposit that secures your child's space for the June 15-18 camp. Rain, shine or emergency, this deposit is nonrefundable. The remaining balance of $300 will be paid in person on the first day of the camp.

$300.00 Quantity

Total

$0.00

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2026 Watersports Summer Camp Registration Form

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