Registration Form

Camper’s Name_______________________________

Address______________________________________

City_________________State_____Zip____________

Phone (     )________________Work Phone_________

Email Address_______________________________

Emergency Contact____________________________

Emergency Contact Phone_______________________

Age___Birthdate________Grade____Gender________

School_______________________________________

City_________________State______Zip___________

Circle T-shirt size: S  M  L  XL  XXL

Ht.______Wt._______

Distances Thrown

Shot PR______ Discus PR_______  Hammer PR_______

Amount Enclosed $________________

Please print, fill out, and send in with the $125.00 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 club,Marietta city schools, Mike Judge, Larry Judge, Ronda Broome,

agents, or employees (hereinafterreferred to as RELEASEE) from any and all liability, claims,

demands, or course of action whatsoever arising out of or related toany 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 uponthe premises where the camp is being conducted.

To the best of my knowledge, I/my child am/is in good physicalcondition 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’sactivities. I am fully aware of risks and hazards connected with this

camp. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANYRISK OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY,

INCLUDING DEATH, that may be sustained by me/my child, or anyloss or damage to property owned by me/my child, as a result of

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

Make check payable to Mike Judge

$125.00 deposit must be received by June 29th to reserve a space in the camp. This camp will be limited

to the first 55 applicants. The balance is due no later than the first day of camp.  Withdrawal from the camp less

than two weeks before the camp will result in the forfeiture of the $125.00 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.

Deposit: Due ASAP

Balance: Due June 29th

Make checks payable to MIKE JUDGE

SEND CHECK TO:

MIKE JUDGE

907 Fox Hollow Way

Marietta, GA 30068