| Camp (Circle One) |
Men's All Day Camp |
Shooting Camp |
| |
|
|
| Date |
July 21-25, 2008 |
July 14-17, 2008 |
| Cost |
$150 |
$95 |
| Name |
> |
| Address |
> |
| City, State, Zip |
> |
| Grade in Fall: |
Birthdate: |
Phone: |
| Age at time of camp: |
Sex:
_____M _____F |
Email: |
| Emergency Contact |
> |
| Emergency Phone |
> |
| Parent/Guardian Approval |
X (sign
here)_________________________________________________________________ |
Waiver: By signing this application I am declaring that I understand that inherent in
this activity is the potential for injury. I further represent that my
child is physically and emotionally capable of fully participating in all
activities associated with the camp. I acknowledge and agree that Dick
Shilts, his employees, agents and contractors, has not made, and has no
obligation to make, any determination as to my child's fitness for participation
in this activity and that Dick Shilts, his employees, agents and contractors,
shall not be liable for any loss, injury or death related to my child's
attendance and participation. My signature on this document further
indicates my permission for my son/daughter to have his/her picture displayed on
the www.dickshilts.com website.
Medicals: Each applicant is encouraged to have had a physical check-up within the last year.
A medical statement from a physician will not be required. Parents will be
required to sign a waiver indicating applicant's capability to fully participate
in camp activities.