South Denver Fencing Academy, LLC

2008 Camp Registration Form 

Last Name: ____________________   First Name: ___________________   MI: ______

 Street Address: ___________________________________________ Apt # ____________

 City: ________________________ State: ________ Zip Code: __________

 Phone #’s    Home: __________________________       

    Work (Mom): __________________________       Work (Dad): ___________________________

    Cell (Mom): ___________________________        Cell (Dad): ____________________________

Email Address: ____________________@___________       Date of Birth _____/_____/________

Do you have any allergies/medical conditions that SDFA should be aware of?  If so, please give details:  __________________________________________________________________________

 If fencer is under the age of 18, please fill in below (include address if different from above):

Parent’s name: ____________________________ Address: ____________________________

                          City: ________________________ State: _______  Zip Code: ______________

Parent’s name: ____________________________ Address: ____________________________

                          City: ________________________ State: _______  Zip Code: ______________

Parent/Legal Guardian: _______________________________   Date: _____/_____/________

Fencer’s signature if over 18.  If the fencer is under the age of 18, the Parent/Legal Guardian must sign registration form.

 Session/s you are registering for (mark all that apply):

       Session 1       June 9 – 13        _______    (Foil)                        

       Session 2       June 23 – 27      _______     (Summer Nationals Prep Camp)

       Session 3       July 14 – 18       _______     (Foil/Epee)

       Session 4       July 28 -Aug 1   _______     (Foil)

 

M – F       9 – 3      $275/SDFA class members*     $325/Non-SDFA class members*

*Pay all 5 day camp fees by June 1st and receive a $25 discount per session

Introduction to Fencing Camps:     3 day sessions          9 – 12:30          $100/fencer

       Session 1     June 16 – 18        _______

       Session 2      July 23 – 25        _______

 A $50 non-refundable deposit is due upon registration for all sessions.

SOUTH DENVER FENCING ACADEMY, LLC

CAMP WAIVER OF LIABILITY

 I understand and appreciate that the participation in fencing as a sport carries a risk to me of serious injury, including permanent paralysis or death.  I agree to abide by the rules of South Denver Fencing Academy, LLC and the United States Fencing Association.  I enter the classes and camps sponsored by South Denver Fencing Academy, LLC voluntarily and at my own risk, and knowingly recognize, accept, and assume this risk and release South Denver Fencing Academy, LLC, the United States Fencing Association, and their sponsors, employees, agents, contractors, volunteers, camp organizers, and officials from any and all liability.

_____________________________________     X_______________________________________

Fencer’s Printed Name                                                                            Fencer’s Signature                                             Date

 _________________________________________________________________________________

Signature of Parent or Guardian for Minor                                                              Date

 CONSENT FOR MEDICAL TREATMENT

This is to certify that on this date, I, ________________________________, give my consent to South Denver Fencing Academy, LLC and its representatives to obtain medical care from any licensed physician, hospital or clinic for the fencer/s named below for any injury or illness that may arise during activities associated with classes and camps sponsored by South Denver Fencing Academy, LLC.

 _________________________________           x______________________________________

Fencer’s Printed Name                                                                     Fencer’s Signature                                               Date

 ______________________________________________________________________________________

Signature of Parent or Guardian for Minor                                                        Date

Address:  ___________________________________ City:  ___________________ Zip:  __________

Phone #:  Home __________________ Work _________________ Cell __________________

Birth date if fencer is under the age of 18:  ______/______/__________

If said fencer has medical insurance, please provide the carrier information:

__________________________________     __________________________________

Name of Carrier                                                                      Name of Policyholder

 _____________________________________________        _____________________________________________

Address of Carrier                                                                    Policy Number

Emergency contacts (in the order SDFA should contact):

 Name:  _____________________________     Phone #:  ________________________

Name:  _____________________________     Phone #:  ________________________

Name:  _____________________________     Phone #:  ________________________

 PHOTOGRAPHY WAIVER

Any photographs taken during classes or camps are the property of South Denver Fencing Academy, LLC and may be used at their discretion.

X____________________________________    X_________________________________________

 Fencer’s Signature                                       Date                                 Signature of Parent or Guardian for Minor                Date   

 

SDFA Camp Code of Conduct

In order to ensure a safe, productive and sportsmanlike atmosphere for all our members, everyone who uses our facility must adhere to our code of conduct, and is expected to hold one another to these standards.  By using our facilities, you agree to abide by this code and be subject to its disciplinary provisions.

We expect you to show respect for our campers, coaches, visitors, staff, facility and the rules of the activities.  We expect you to be of good will with one another when differences arise and be generous and flexible as we strive to meet the needs of all of our campers.  Use of tobacco products, alcohol, and illegal drugs are prohibited on the premises.

 

Yellow Cards

 Campers must behave in a sportsmanlike manner at all times.  Campers who continue to violate these guidelines after being told to stop will be required to sit out of activities for a period of time determined by the coach and staff.  Parent/Guardian will be notified for fencers under age 18.  This includes, but is not limited to the following specific prohibitions:

 

 Black Cards

 

SUCH BEHAVIOR WILL RESULT IN A CAMPER BEING REQUIRED TO BE PICKED UP BY A PARENT OR GUARDIAN AND REMOVED FROM THE FACILITIES IMMEDIATELY AND INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING SPECIFIC PROHIBITIONS:

 

Campers who are black-carded are subject to suspension from the club and will be prohibited from the use of the facilities.  Refunds will not be issued for unused fees.

I agree to abide by the South Denver Fencing Academy’s Code of Conduct, and be subject to the Code’s disciplinary provisions.

 

__________________________________________________                   ________________

Signature of Fencer (all fencers must sign)                                                 Date

 

__________________________________________________            _________________

Signature of Parent/Guardian (for fencers under age 18)                                Date