Camp Registration

Please fill out the Camp Registration form below and press submit or download the PDF-form by clicking on the PDF logo and fax it to 770-405-2490.

WELLNESS AND SPORTS CAMPS REGISTRATION FORM

Camp Name:		Camp Date(s):
Participant’s Name:
Birthday:		Age:
Parents Name(s):		2nd Parent:
Phone (Home):		Phone (Work):
Address:
City:		State and Zip:
Email
Emergency Contact: #1		Phone:
Relation to Participant:
Emergency Contact: #2		Phone:
Relation to Participant:
List any medical situations involving player (i.e. allergies, asthma, etc.)

WAIVER

IF UNDER 18 YRS OF AGE : In consideration of Xcelerate Sports Development allowing my child to attend, I (we) individually and as Legal guardian(s) and/or parent(s) of the in this form mentioned participant, do hereby release, discharge, indemnify and hold harmless Xcelerate Sports Development and its owners, directors, officers, employees, agents, successors, and assigns from and against, and waive any and all claims or liabilities from any injuries, losses, or damages including without limitations, injuries to my child, myself and/or property, arising out of or incident to my child’s participation in Xcelerate Sports Development, whether caused in whole or in part, by the negligent act(s) or omission(s) of its owners, directors, employees, or agents. I hereby authorize the staff of Xcelerate Sports Development to act for me according to their best judgment, in any medical emergency for my child.

I agree to these terms