Join us for a fun, skills packed camp beneficial to all skill levels! Jackals Youth Rugby Camps are 3 half-days focused on developing and rapidly advancing youth talent. Led by Jackals Assistant Coach and former USA Eagle Nese Malifa, participants will gain knowledge from professional coaching. Each participant will receive a Jackals shirt, water bottle, and ticket voucher to a 2022 home match! Please fill out a separate form per participant.
Participant Name
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First Name
Last Name
Birthday
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Month
-
Day
Year
Date
Incoming Grade in 2021-2022
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Gender
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Male
Female
Other
Address
Street Address
Street Address Line 2
City
State
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School/Club Team (if applicable)
Position (if applicable)
Rugby Experience
*
None
1
2
3
4
Experienced
5
1 is None, 5 is Experienced
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
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Emergency Contact Relationship to Participant
*
Parent/Guardian Name (if different than Emergency Contact)
First Name
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Parent/Guardian Email
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example@example.com
Participating Sibling Name(s) (if applicable)
Please list any medical conditions or allergies:
T-Shirt Size (specify youth or adult)
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July 13-15th - Jr. Jackals Rugby Camp
5th-8th Graders from 8:30-11:30am
$
90.00
July 13-15th - Jr. Jackals Rugby Camp
5th-8th Graders from 8:30-11:30am and a Replica Jackals Ball
$
110.00
Credit Card
Waiver
I understand participation in the Camp is completely voluntary and agree that Camp is provided through the Dallas Jackals Foundation (“Jackals”) to enhance my child’s education and that NO INSURANCE COVERAGE MAY EXIST THROUGH JACKALS TO COVER ANY CLAIMS THAT MAY ARISE OUT OF MY CHILDS PARTICIPATION IN THE CAMP. In consideration for Jackals arranging this opportunity for my child to participate in this Camp and enhancing my child’s educational and competitive experience, and knowing that I would be required to sign this Release of Liability (“Release”), I acknowledge that I have fully read this Release and hereby execute this Release with the intent to bind myself, my spouse (if applicable), my heirs, assigns, and legal representatives. I further state that I am at least 18 years of age and competent to sign this affirmation and release. I understand and agree that on some occasions, my child must arrange his/her own transportation related to the Camp and/or on some occasions, Jackals may arrange transportation for my child. I further understand that my child’s decision to accept transportation from Jackals is completely voluntary and accepted at his/her own risk, that he/she is not required to accept such transportation, and that such transportation will not be covered by any Jackals insurance. If my child arranges his/her own alternate transportation, I understand that he/she must provide his/her own automobile collision and liability insurance, at his/her expense if my child chooses to drive. Further I understand and agree that whatever alternate mode of transportation he/she may choose will not be covered by any insurance from Jackals. I fully understand and acknowledge that certain elements of Camp may be physically hazardous and emotionally demanding and that by my child’s participation in the Camp, he/she faces the risk of accidental and/or other injury. These risks include, but are not limited to, (1) traveling to and from Camp, (2) loss or damage to personal property; (3) injury or fatality due to, and/or related to, (a) walking, running, jumping, swimming, handling athletic equipment, being exposed to others handling athletic equipment, colliding with other players, and/or other physical activity, (b) head, neck, arm, leg, and/or back injuries, (c) the condition of facilities, (d) exposure to inclement weather, outdoor terrain, and all the risks inherent therein, (e) slips and falls, and (f) any and all other aspects and stress related to Camp, including interaction with personnel at other locations, who may not be employees of Jackals, among others. I understand and assume the risks of my child’s participation in the Camp. I have fully investigated the nature of the Camp, including whether the participants will be subjected to physical and/or emotional stresses, and assume the risks of my child’s participation in the Camp. I agree that my child’s participation in the amp is entirely voluntary and that my child is under no obligation to take part in the Camp. I am fully aware that my child may suffer these or other injuries arising out of my participation in the Camp and I acknowledge that the Camp may be a dangerous activity. However, I allow my child voluntarily to assume these risks and participate in the Camp. My child and/or I agree to advise his/her supervisor at any point when my child questions his/her ability to participate in the Camp. I further acknowledge that my child has asked for and has received reasonable accommodations for any disability my child may have brought to the attention of the Supervisor, having first presented valid certification of his/her disability to the Supervisor. I EXPRESSLY AGREE AND INTEND THAT MY CHILD’S PARTICIPATION IN THE CAMP SHALL BE UNDERTAKEN BY MY CHILD AT HIS/HER OWN RISK AND THAT NEITHER JACKALS, ITS TRUSTEES, OFFICERS, EMPLOYEES, AGENTS NOR ASSIGNS SHALL BE LIABLE FOR ANY INJURIES, DAMAGES, CLAIMS, DEMANDS, OR CLAUSES OF ACTION WHATSOEVER WHICH MAY ARISE OUT OF OR IN CONNECTION WITH MY CHILD’S PARTICIPATION IN THE CAMP, WHETHER FROM ACTS OF ACTIVE OF PASSIVE NEGLIGENCE ON THE PART OF MY CHILD OR THE PART OF THE JACKALS, ITS TRUSTEES, OFFICERS, AGENTS AND ASSIGNS, AND I DO HEREBY FOREVER RELEASE, DISCHARGE, INDEMNIFY, HOLD HARMLESS AND WILL DEFEND JACKALS, ITS TRUSTEES, OFFICERS, EMPLOYEES, AGENTS AND ASSIGNS FOR ANY SUCH INJURIES, DAMAGES, CLAIMS, DEMANDS, ACTIONS, OR CAUSES OF ACTION. The terms of this Release of Liability are to be governed by and construed under the laws of the State of Texas. In the event any term of provision of this Release of Liability is found to be unenforceable or void, in whole or in part, the term or provision concerned shall be construed as valid and enforceable to the maximum extent permitted by law, and the balance of this Release of Liability shall remain in full force and effect. I agree that exclusive venue for any dispute arising between Jackals and me involving this Release of Liability in any ways shall be in Dallas County, Texas.
Signature
BY ACKNOWLEDGING AND SIGNING ABOVE, 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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