Boot Camp Registration Package

							                   BOOT CAMP REGISTRATION PACKAGE




Website: www.nextlevelconditioning.org      Email: nextlevelconditioning@gmail.com




                           PAGE 1 of REGISTRATION PACKAGE
Camper’s Name                                                  Date Birth               Age         Wgt

Address:

City:                              State:            Zip:              Home Phone:

Cell Phone:                                   Email Address:

EMERGENCY INFORMATION

Family Doctor:                                         Doctors Number:

In Case of Emergency, Contact:                                                 Phone:

Medical concerns the counselor should be aware of




Signature:                                                                     Date:




Thank You for your participation and support. We want this to be a successful and fun camp for all participants. If
you have any suggestions or questions, please contact David Mitchem 337-5933.




                                   PAGE 2 of REGISTRATION PACKAGE
           Medical Treatment Permission And Waiver of Liability

Statement

In the event of an emergency occurring while at camp, I grant permission to Next Level Conditioning
Staff, Counselors and / or Representatives to take whatever action is deemed necessary to assist or aid me.
I hereby further authorize Next Level Conditioning consent for me,                                 to
receive medical treatment. I also assume responsibility for payment of any such treatment.



In consideration of being permitted to participate in camp activities, I do hereby for myself
__________________________________, my heirs, executors, administrators, agents and assignees
release and forever discharge event sponsors, counselors, the Next Level Conditioning organization, their
agents, predecessors, successors and assigns, and all other persons involved in organizing and managing
this event from all claims, demands, losses, damage actions, cause of actions or suits at law or in equity of
whatsoever kind of nature, arising out of camp activities, including without limitation, any claims for
personal injuries or losses to the aforementioned participant, which I may otherwise be able to assert
either on my own behalf or on behalf of that aforementioned participant.


        Signature Section – To be completed by parent/legal guardian


        Signature:                                                 Date Signed __

        Name:                                             Relationship _____________        ______

        Home Phone__             ________________ Cell Phone ____                   _____________

        Address________________________

        City/State___________                     ___     ____________ Zip_____

        Insurance Carrier ___________                     ___      ____________

        Policy Number ___________                         ___      ____________




                                 PAGE 3 of REGISTRATION PACKAGE