WINTER BREAK CAMP

Additional adult(s) and/or person(s) authorized to pick up child:

REGISTRATION OPTIONS

SINGLE ATHLETE REGISTRATION:
Daily Registration:
Multi-day Registration:
AM Extended Care:
PM Extended Care:
SIBLING REGISTRATION:
SIBLING REGISTRATION x2: CORE HOURS
Sibling AM Extended Care:
PM Extended Care:
SIBLING REGISTRATION x3: CORE HOURS
Sibling AM Extended Care:
PM Extended Care:

MOMENTUM³ RELEASE INFORMATION

CANCELLATIONS, REFUNDS & MAKE-UPS:
  1. Momentum³ reserves the right, prior to the start date or after, to cancel a course due to insufficient registration with full refund.

  2. There is an $80 non-refundable deposit included in the price of all week long camps (Winter, Spring, & Summer), if requested 14 days prior to camp. After camp start date, no refunds will be issued.

  3. There is a $30 non-refundable deposit included in the price of all mini-camps and clinics, if requested 14 days prior to camp. $35 if re- quested less than 14 days prior to camp. After the program start date, no refunds will be issued.

  4. Requests for program fee refunds (not including the non-refundable registration fee and fee for any days attended) will be considered. Please allow 2-4 weeks for processing.

  5. Camp, clinic, or training fees are not transferable.

MEDICAL RELEASE AND ASSUMPTION OF RISK: (For any student participating in any class)

By the very nature of sports, Momentum³ programs carry a risk of physical injury. No matter how careful the participant and the coach are, the risk cannot be eliminated. The risk of injury includes minor injuries such as bruises and more serious injuries such as broken bones, dislocations and muscle pulls. Momentum³ is bound by law to inform all participants and/or their guardians of the risk involved in participation in its’ sports programs. Anyone participating in a Momentum³ program must sign the notice on the application, and adhere to the safety rules. These rules will be covered on the first day of camp or class and will be revisited throughout the program. In consideration for Momentum³, acceptance of the applicant, and in consideration of the applicant’s opportunity to improve skills through the use of the Momentum³ staff, equipment and facilities in use, those legally responsible for the name enrolling student realize the risk of injury involved and hereby agree to assume the responsibility of such said athlete and further agree to save and hold harmless Momentum³, its employees, and all others concerned, and to indemnify them against loss, intending to be legally bound.

I certify that the enrollee has no condition that prohibits full participation in the activities during Momentum³ programs. I assume all risks while my child is enrolled and hereby release Momentum³, or any of its employees, for any injury or damage suffered in connection with the aforementioned, Momentum³, and its equipment. In case of emergency, if I cannot be reached, I authorize Momentum³, its agents and employees, to contact and secure necessary medical attention for my child.

PRODUCTION RELEASE:

I herby irrevocable consent to and authorize the use and reproduction by Momentum³, or anyone authorized by Momentum³ of any and all film or video images, name, and statistical information which you have recorded of my child, for any purpose whatsoever, without further compensation to me or my child. All negatives and positives, together with the prints and/or video footage shall constitute your property, solely and completely. I hereby release all individuals and organizations involved in the above listed production from any privacy, defamation, or other claims I may have arising out of the exhibition, cablecast, broadcast, or promotion of the aforementioned.

Parent/Guardian Signature: *
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