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Entry Form (click here for a printer - friendly version)
Dwight Stones Presents: The ASICS® Champions' Track & Field Academy
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Camp Plan: |
_______ | $399 Commuter |
| _______ | $499 Resident (includes 2 nights luxury hotel accommodations & all meals) | |
| _______ | $99 Coach - Same as Commuter Plan, Resident Coaches Add $50/Night. Free tuition for coaches with 3 or more paid campers. |
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| _______ | $50 for each add'l night hotel stay beyond the included 2 nights | |
| $______ | Total A 50% Deposit is due at time of registration. |
Parental Consent/Participation Waiver: I hereby grant permission for my child to attend the "Dwight Stones Presents: The ASICS® Champions' Track & Field Academy. I verify that my child has had a physical exam in the past year and is able to participate in the activities related to the camp. I agree to indemnify, hold harmless and defend DSE, Dwight Stones, Saddleback Valley Unified School District, Hilton Garden Inn, Foothill Ranch, CA, all camp sponsors and/or their agents or employees from any and all liability for injury, to my child, as well as any injury or damage caused by my child. Should medical treatment for my child be necessary, I hereby authorize any physician or trainer selected by camp personnel to order and conduct medical or surgical procedures necessary.
Parent or Guardian Signature___________________________________________
| Payment: | Dwight Stones 4790 Irvine Blvd., Suite #105 Irvine, CA 92620-1998 |
| Information: | Camp Line 949-653-2148 FAX Line 866-716-4938 E-Mail: CoachStones@sbcglobal.net Web: http://www.DwightStones.com |
No refunds after June 30, 2006
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