Air Rifle Summer Camp: New Reg.

Air Rifle Summer Camp: New Athlete

Please fill out the registration form below, in its entirety.

Athlete Name *

First

Last

Parent Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Confirm Email

Phone *

Athlete DOB *//

Athlete School (2020-2021) *

Athlete Grade (2020-2021) *

Athlete School (2021-2022) *

Athlete Grade (2021-2022) *

Athlete T-Shirt Size *

Emergency Contact

Name *

First

Last

Phone *

Relationship to Athlete *

Parent Permissions and Agreement

By checking this box, you agree to the terms and conditions below

By providing your eSignature and clicking the "Submit" button, you:

(1) fully understand and agree that your eSignature holds identical legal weight to your handwritten signature;
(2) are hereby giving your child permission to take part in the Air Rifle Summer Camp
(3) are agreeing that you will not hold The X Count, The X Count staff, The X Count sponsors, the facility owner, or the camp sponsor(s) liable for any injuries that may occur during the total time of the camp;
(4) fully understand that this is not an activity that comes without risk to person and/or property and will not hold The X Count or its staff liable for any physical injury or damage to personal property that occurs during the camp;
(5) are declaring that you have medical and hospitalization insurance to cover any injuries that may occur during the camp.

Parent Signature *

Payment

2021 X Count Air Rifle Summer Camp

Price: $ 150.00

Stripe Credit Card *

Card

Name on Card