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2. Participant's First Name*
3. Participant's Last Name*
5. Participant's Date of Birth*
   Participant's Date of Birth
7. Phone Number*
8. Email Address*
10. Parent or Guardian's First Name*
11. Parent or Guardian's Last Name*
13. Is there a physical, medical, or mental condition that may limit his/her full participation in this program?*

    1. Yes
    2. No
14. If yes, please detail the condition.
16. Check the program you are participating in*

    1. Youth Certification
    2. Cake Decorating
    3. Basketball Training with Shannon
    4. Tumbling
    5. Karate

    1. Softball CAMP
    2. Volleyball CAMP
    3. Tennis CAMP
    4. Tumbling CAMP
    5. Basketball CAMP
18. General Release

    For the Participant, Parent or Guardian:

    I understand the inherent dangers involved in fitness and aquatic programs that may lead to possible accident, injury or death. I feel confident that my child will be able to understand and follow all safety precautions. I also understand that there will be no refunds given.

    The undersigned jointly and severally hereby forever release, discharge, acquit, and forgive Eagle Pointe Recreation Complex, their agent, employees, contractors, and volunteers, from any and all claims, actions, suits, demands, agreements, and each of them, if more than one, liabilities, judgment and proceedings both at law and in equity arising from the beginning of time to the date of these presents. This release shall be binding upon and inure to the benefit of the parties, their successors, assigns and personal representatives.

20. First Name*
21. Last Name*
22. Today's Date*
    Today's Date
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field