Quo Vadis Kids 21.1

March 29 - May 20

(8 Week Camp)

Monday Nights at 7 PM - CrossFit Kids Thursday Nights at 7 PM - Self Defense

Ages 5-11

CrossFit & Self Defense:

Registering 1 Child ($140)

2 Children ($260, $20 discount)

3 Children ($380, $40 discount)

CrossFit Kids ONLY Monday Nights:

Registering 1 Child ($84)

2 Children ($156, $12 discount)

3 Children ($228, $24 discount)

Self Defense ONLY Thursday Night:

Registering 1 Child ($84)

2 Children ($156, $12 discount)

3 Children ($228, $24 discount)

Family Name *

Mother's Name

Father's Name

Address 1 *

City, State *

Postal Code *

Guardian Phone *

Guardian Email Address *

Child Name *

Age *

Date of Birth (Month/Date/Year) *

Shirt Size *

Gender *

Allergies or Medical Conditon

Child Name

Age

Date of Birth (Month/Date/Year)

Shirt Size

Gender

Allergies or Medical Conditon

Child Name

Age

Date of Birth (Month/Date/Year)

Shirt Size

Gender

Allergies or Medical Conditon

Emergency Information: In an emergency, and if a parent cannot be contacted, you have my permission to contact the following person to help make decisions regarding the care for my child: *

Phone Number *

General Waiver PLEASE NOTE: This waiver of Liability, Release, Acknowledgement of Risk, and Indemnification Agreement (“Waiver Agreement”) is intended to be, and is, legally binding. By signing the “CrossFit Quo Vadis Registration” you are agreeing to all terms set forth in this Waiver Agreement. You and/or the person on whose behalf you are signing, are waiving the right to bring any type of action, whether in court or otherwise, to recover compensation or obtain any other remedy for any personal injuries, damages to property, any accident or incident of any type, or death, arising out of or related to your use of CrossFit Quo Vadis, its facilities, grounds, climbing walls, exercise areas, classes, equipment, whether the use is supervised or unsupervised. While CrossFit Quo Vadis, offers these activities in a controlled environment, there is still an assumed risk of injury to persons using CrossFit Quo Vadis. In agreeing to this Waiver Agreement, I hereby acknowledge, understand, and agree on my behalf, and upon behalf of the person for whom I am signing, that the use of CrossFit Quo Vadis, its facilities, equipment, climbing walls, classes and/or participating in activities sponsored by CrossFit Quo Vadis have inherent risks. These risks include, but are not limited to, any injury of damage resulting from: Negligence of employees, volunteer assistants, independent contractors of CrossFit Quo Vadis, or Stephen Thompson. Negligent misuse of the facility, climbing walls, or equipment of CrossFit Quo Vadis; falling off or impacting against the climbing walls, impact surface, floors, or anything else; rope abrasion, entanglement or other activities occurring on the premises; cuts or abrasions resulting from any cause whatsoever; failure of the climbing walls or equipment, whether inside or outside; personal health problems, whether mental or physical; negligence of other climbers, visitors, or observers or persons who may be present in or around the climbing area or facility; and/or negligence or lack of adequate training of any person(s) who seek to assist with medical or other help either before or after any injury or damage may occur. *

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Upon receiving this registration form, the CrossFit Quo Vadis crew will contact you confirming your registration and provide any addition information that may be needed.

Please continue to the next page to fulfill payment requirements via PayPal.