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July 12 and 13
Boys and Girls Grades 8-12 10:00-12:00
Grades 8-12 - Limited Spots Available
Boys and Girls Grades 3-7
Grades 3-7 - SOLD OUT
Greenheck Fieldhouse
Please make sure to BRING your own BALL, GYM SHOES, and WATER BOTTLE
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Parent/Guardian Name
*
First
Last
Participant Name
*
First
Last
Boys Player/Girls Player
*
Boys Player
Girls Player
Participant Grade Level - CURRENTLY Grades 3-7 are Sold Out - Sorry for any inconvenience
*
8th
9th
10th
11th
12th
Contact Email
*
Phone
*
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
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California
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Connecticut
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District of Columbia
Florida
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Hawaii
Idaho
Illinois
Indiana
Iowa
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Montana
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New Hampshire
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New York
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Ohio
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
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Washington
West Virginia
Wisconsin
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State
Zip Code
School District
*
HEALTH & GENERAL HISTORY: Should the player be restricted from any activity please note:
Please identify any medical condition or medical history that would require special attention:
Camp Registration Cost
*
July 12 and 13 - $65.00
Payment Options
Credit Card (PROCEED BELOW)
Venmo @UltimateTeamCamps
Mail: UTC, 1540 Brookhaven Way, Plover, WI 54467
Square
Card
Name on Card
Total
$0.00
Signature
*
Clear Signature
As the parent (guardian) of the named player I give permission to receive emergency medical or surgical treatment and hospitalization if necessary. I understand that every attempt will be made to contact me, or the emergency contact named above, before taking this action. I will be financially responsible for any medical attention needed during camp or resulting from an injury received at camp. My medical insurance shall be the insurance coverage for any medical treatment. I further agree that my child can receive over-the-counter remedies if necessary. (Tylenol, Sudafed, etc.) Please give special instructions above if you do consent to your child receiving over-the-counter medications. I HAVE READ THE POLICIES AND FULLY UNDERSTAND MY OBLIGATIONS STATED THEREIN AND ALSO THE RIGHTS OF Ultimate Team Camps, AND HERBY AGREE TO ACT IN ACCORDANCE. I also agree that my child may be transported by bus and/or camp vehicle to an off-site medical center or for emergency medical treatment. The undersigned further expressly agrees that the attached waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. In consideration of my minor child/ward (“my child”) being allowed to participate in UTC Fire, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that: 1. The risk of serious injury from the sports activities involved in this program is always present due to the nature of the sport (s); and 2. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation; and 3. I willingly agree to comply with the program’s stated and customary terms and conditions for my child’s participation. If, however, I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from participation and bring such to the attention of the nearest official immediately; and 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the Camp, Ultimate Team Camps, its affiliates, officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for activity (“Releases”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, regarding my child and/or arising from his/her activities, WHETHER ARISING FROM NEGLIGENCE OF THE RELEASEES OR OTHERWISE, except for willful misconduct, or otherwise to the fullest extent of the law. I HAVE READ THIS HEALTH FORM AND RELATED CERTIFICATIONS, THE RELASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND THEIR TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
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