BARK Rec Sports Camp Registration Form
Enrollment Information: Child’s T-Shirt Size
Child’s Name ______Age: ______14/15 Grade Level:______
Address: ______Date of Birth ___/___/_____
Parents/Guardians: ______Student / Faculty/Staff / Alumni Assoc.
Phone #: ______Work #: ______Cell #: ______
Doctor: ______Phone #:______
Email ______How did you hear about us? ______
Insurance Provider: ______Policy #: ______
Special notes about your child that you would like the staff to be aware of: ______
______
Emergency Contact Information/ Names of persons authorized to pick-up child:
(In the order you would like us to contact if we are unable to reach someone at the phone numbers above.)
1. ______Phone #______
2. ______Phone #______
3. ______Phone #______
If an emergency should arise which requires immediate attention and we, as Parents/Guardians, cannot be contacted you are authorized to take whatever steps are needed to protect the health of this child.
Parent/Guardian Signature: ______Date: ______
Attendance: Please indicate only those sessions your child is going to attend.
Session 1: June 16-20 ______Session 2: June 23-27 ______
Session 3: July 7-11 ______Session 4: July 14-18 ______Session 5: July 21-25______
BARK is open from 8:00am to 4:30pm on Monday through Friday. If you know you are going to be late, please call Rec Sports and Fitness so you will not cause worry for the staff and for your child. Extended care is available for campers needing to be dropped off early and/or picked up later. Extended care is provided from 7:00am-8:00am and again from 4:30pm until 5:30pm at an additional cost of $30.00 per week which must be paid in advance.
Incident/Write-Up:
1st incident: parent communication
2nd incident: parent notified of expulsion with 3rd write-up
3rd incident: expulsion from the program
Parent/Guardian Signature: ______Date: ______
By signing, you agree to adhere to all policies of the BARK Rec Sports Camp and Rec Sports & Fitness Department.
BARK Rec Sports Camp
RELEASE FORM
Release of Liability
On this ______day of ______, 201__, intending to be legally bound hereby, the undersigned agrees and does hereby release from liability and indemnify and hold harmless The State of California, the trustees of the California State University, the California State University, Fresno, the California State University, Fresno Association, Inc., the California State University, Fresno Athletic Corporation, the California State University, Fresno Foundation, and all of said entities’ officers, directors, employees, agents, representatives, and assigns are not responsible for injuries including death as regards to the BARK Rec Sports Camp and any use of the facilities. This release is for any and all liability for personal injuries (including death) and property losses or damage occasioned by, or in connection with any activity or accommodations for this event. The undersigned further agrees to abide by all rules and regulations promulgated by Rec Sports & Fitness and/or its affiliate groups and vendors throughout the participation of the program.
Subjects Name: ______Date: ______
Parents Name: ______Signature: ______
Picture Release
I hereby grant the BARK Rec Sports Camp (BARK) (hereinafter called THE CAMP), their nominees, designees, successors, and assigns of those for whom they are acting full authorization and the absolute right and permission to sell, assign, convey, reproduce, copyright, use, or publish photographic reproductions, portraits, testimonials, or pictures of me, motion picture or video tape pictures of me, or in which I may be included in whole, in part, or in composite, or in which character or form is distorted, in conjunction with my own or any other picture, product, person, name, or reproduction, in color or otherwise, made through any media at its studios or elsewhere, for art, advertising, promotional, presentation, efforts, commerce, business, or trade or any other lawful purpose whatsoever.
I hereby waive any right that I may have to inspect or approve the finished product or the advertising copy, which may be used in connection therewith, or the use to which it may be applied.
I hereby release, discharge, and agree to hold harmless THE CAMP, its nominees, designees, successors, and assigns, or others for whom they are acting, from any liability of any nature or description by virtue of any use whatsoever, whether intentional or otherwise, or from any change that may occur or be produced in the taking of said pictures, or any processing tending towards the completion of the finished conspicuous ridicule, scandal, reproach, scorn and indignity.
I am over the age of 18.
SUBJECTS SIGNATURE: ______
ADDRESS: ______
PHONE: ______
WITNESS: ______
MINOR’S RELEASE
If under 18 years old, the parent or legal guardian of the model must sign below.
I, parent and/or guardian of ______(Minor’s Name) do hereby consent and grant permission to all of the foregoing.
PARENTS SIGNATURE ______DATE ______