Please print, fill out, and send in with the $100.00 deposit

Insurance Information

Please indicate the insurance company and policy number

under which your child/legal ward is insured

Person carrying insurance____________________________

Company_________________________________________

Policy number_____________________________________

Waiver of Liability and Hold Harmless

Agreement/Consent to Medical Treatment

In consideration of being allowed to participate in this camp, I

hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO

SUE Throw1deep Sports, Inc, Throw1deep,Mike Judge, Larry Judge,

agents, or employees (hereinafter

referred to as RELEASEE) from any and all liability, claims,

demands, or course of action whatsoever arising out of or related to

any loss, damage, or injury, including death, that may be sustained

by me/my child, or to any property belonging to me/my child,

WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEE, or

otherwise, while participating in this camp, or while in, on or upon

the premises where the camp is being conducted.

To the best of my knowledge, I/my child am/is in good physical

condition and I am not aware of any physical infirmity which would

place me/my child at risk to participate in any way with the camp’s

activities. I am fully aware of risks and hazards connected with this

camp. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY

RISK OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY,

INCLUDING DEATH, that may be sustained by me/my child, or any

loss or damage to property owned by me/my child, as a result of

being engaged in the camp’s activities, WHETHER CAUSED BY THE

NEGLIGENCE OF RELEASEE or otherwise. I further hereby AGREE

TO INDEMNIFY AND HOLD HARMLESS the RELEASEE from any

loss, liability, damage or cost, including court costs and attorneys’

fees, that may accrue related to my/my child’s participation in the

camp, WHETHER CAUSED BY NEGLIGENCE OF RELEASEE or otherwise.

During the period of the camp, I hereby give permission for the

staff of this camp to administer appropriate medical attention to me/my

 child in the event

of an accident, illness, or injury. I will be responsible for any and all

costs of medical coverage and treatment provided not covered by

insurance.

It is my express intent that this Waiver of Liability and Hold

Harmless Agreement/Consent to Medical Treatment shall bind the

members of my family and spouse, if I am alive, and my heirs,

assigns and personal representative, if I am deceased, and shall be

deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT

NOT TO SUE the above-named RELEASEE. I hereby further agree

that this Wavier of Liability and Hold Harmless Agreement/Consent

to Medical Treatment shall be construed in accordance with the

laws of the State of Georgia. In signing this release, I acknowledge

and represent that I have read and understand it and sign it voluntarily;

I am at least eighteen (18) years of age and fully competent;

and I execute this Release for full, adequate and complete consider -

ation fully intending to be bound by same.

I HAVE READ THIS WAIVER OF LIABILITY AND FULLY UNDERSTAND

ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL

RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY

WITHOUT ANY INDUCEMENT.

Name_____________________________________

Signature__________________________________ Date________

(If eighteen (18) years of age or older)

Parent’s printed name_________________________

Signature__________________________________Date__________

(If participant under eighteen years of age)

Registration Form

Camper’s Name_______________________________

Address______________________________________

City_________________State_____Zip____________

Phone ( )________________Work Phone_________

Emergency Contact____________________________

Emergency Contact Phone_______________________

Age___Birthdate________Grade____Gender________

School_______________________________________

Address______________________________________

City_________________State______Zip___________

Circle T-shirt size: M L XL XXL

Ht.______Wt._______

Shot PR______ Discus PR_______  Hammer PR_______

Amount Enclosed $________________

Varsity Letter Award Winner? Yes or No

Make check payable to Mike Judge

$100.00 deposit must be received by June 22th to

reserve a space in the camp. This camp will be limited

to the first 35 applicants. The balance is due no later than

the first day of camp. Once an application is received, additional information

will be mailed. Withdrawal from the camp less

than two weeks before the camp will result in the forfeiture

of the $100.00 deposit.

Americans With Disabilities Act

Individuals with disabilities requiring special accommodations

please contact the camp director within a minimum

of seven days before the first day of camp so the

proper consideration may be given to the request.

Register Now!

Only 35 Athletes Accepted 2007

Deadline Notice

Deposit: Due ASAP

Balance: Due June 26th

Make checks payable to MIKE JUDGE