Air Rifle Summer Camp: New Athlete Please fill out the registration form below, in its entirety. Please enable JavaScript in your browser to complete this form.Athlete Name *FirstLastParent Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *EmailConfirm EmailPhone *Athlete DOB *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Athlete School (2020-2021) *Athlete Grade (2020-2021) *Athlete School (2021-2022) *Athlete Grade (2021-2022) *Athlete T-Shirt Size *--SmallMediumLargeX Large2X LargeEmergency ContactName *FirstLastPhone *Relationship to Athlete *Parent Permissions and Agreement By checking this box, you agree to the terms and conditions belowBy 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 *Clear SignaturePayment2021 X Count Air Rifle Summer CampPrice: $ 150.00Stripe Credit Card *CardName on CardSubmit