COED COMPETITIVE ARTISTIC GYMNASTICS

SUMMER CAMP – JULY 2017

PARENTS AND CAMPERS GUIDE

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TABLE OF CONTENTS

WHO CAN ATTEND ........................................................................................................................................ 1

WHAT WE OFFER .......................................................................................................................................... 1

CAMP DATES ................................................................................................................................................. 1

CAMP LOCATION ........................................................................................................................................... 1

WEEKLY SCHEDULE ....................................................................................................................................... 3

STAFF ............................................................................................................................................................. 4

COACHES ....................................................................................................................................................... 4

CELEBRITY GUESTS ........................................................................................................................................ 6

WEEKLY SENIOR COACHES SCHEDULE .......................................................................................................... 6

GYMNASTICS FACILITY .................................................................................................................................. 7

ACCOMMODATIONS ..................................................................................................................................... 8

DINING HALL ............................................................................................................................................... 10

MEALS ......................................................................................................................................................... 10

ADMINISTRATION AND GENERAL STORE .................................................................................................... 12

CAMP RATES ............................................................................................................................................... 12

REGISTRATION: ........................................................................................................................................... 12

CONTACT INFORMATION ............................................................................................................................ 12

CHECK-IN & CHECK-OUT ............................................................................................................................. 12

AIRPORT PICK-UP AND DROP-OFF .............................................................................................................. 13

RECOMMENDED CAMP PACKING LIST ........................................................................................................ 14

WAIVER FORM ............................................................................................................................................ 15

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PINE VALLEY RESORT COED COMPETITIVE ARTISTIC GYMNASTICS

SUMMER CAMP – JULY 2017

WHO CAN ATTEND

Gymnasts who are 7+ and are comfortable being away from home for 6 days can attend the camp.

GIRLS: Junior Olympic Level 3-10

BOYS: Provincial Level 1 – 5 and National Open

WHAT WE OFFER

• Gymnastics training with high profile coaches in a safe and inclusive environment • Indoor and outdoor activities • Dormitory style accommodations (boys & girls separate) • Counsellors on each dormitory floor • Meals provided

CAMP DATES

Our camp runs from Sunday to the following Saturday.

Week 1 July 2-8, 2017 WAG & MAG

Week 2 July 9-15, 2017 WAG & MAG

Week 3 July 16-22, 2017 WAG & MAG

Week 4 July 23-29, 2017 WAG & MAG

CAMP LOCATION

Pine Valley Resort (PVR) is located in Tawatinaw Valley, 85 km north of Edmonton, Alberta.

The Hamlet of Tawatinaw is located within Westlock County, and at one point was a bustling place when the old railway went through. Before the current Highway 2 was built, the old Highway 2 ran through the town which featured a grain elevator and

railway station. With time, people moved into bigger cities, turning the valley into a quiet, peaceful, and serene place.

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With over 300 acres under its ownership and management, our facilities include Pine Valley Gymnastics

Centre, dining hall and dormitory, and Pine Valley Snow Resort. PVR offers first-class training facilities and

retreat for indoors and outdoors activities year round.

B - Dormitory

A - Dining Hall

E - Ski Hill and Ski Chalet

C – Administration and General Store

F- Hiking and biking trails D - Pine Valley Gym Centre

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WEEKLY SCHEDULE

PVR’s facilities are designed for gymnastics and outdoors activities such as mountain biking and hiking.

Each day of the week is scheduled for our campers to maximize gymnastics training, outdoor recreational

activities, healthy meals, balanced social time, rest and relaxation.

DAY TIME ACTIVITY

DAY 1: SUN

1:00 pm – 2:00 pm Arrival & Check In 2:00 pm – 2:30 pm Meeting with Parents and Campers 2:30 pm – 6:00 pm Orientation/ Gymnastic Skill Assessment 6:00 pm – 7:00 pm Dinner 7:00 pm – 9:30 pm Social Activities 9:30 pm – 10:00 pm Quiet Time 10:00 pm Lights Out

DAY 2, 3, 5, 6: MON, TUE, THU, FRI

8:00 am – 9:00 am Breakfast 9:30 am – 12:00 Noon Training #1 12:30 pm – 1:30 pm Lunch 1:30 pm – 2:30 pm Free Time 2:30 pm – 5:30 pm Training #2 6:15 pm – 7:15 pm Dinner 7:30 pm – 9:30 pm Evening Program1 9:30 pm – 10:00 pm Quiet Time 10:00 pm Lights Out

DAY 4: WED

8:00 am – 9:00 am Breakfast 9:30 am – 12:00 Noon Training 12:30 pm – 1:30 pm Lunch

2:00 pm – 6:00 pm Outdoors Activities2 6:15 pm – 7:15 pm Dinner 7:30 pm – 9:30 pm Evening Program 9:30 pm – 10:00 pm Quiet Time 10:00 pm Lights Out

DAY 7: SAT 8:00 am – 9:00 am Breakfast 9:00 am – 12:00 Noon Check-out

1 Guest speakers, campfire, movie night, Q/A, games, and campers’ exhibition 2 Swimming at a nearby lake, mountain biking at ski hill, nature walk, local farm visit, golfing, and horseback

riding lessons. For golfing and horseback riding lessons, extra charges will apply.

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STAFF

DOM KRIANGKUM: CAMP DIRECTOR

Dom is a professional engineer who has a passion for gymnastics and outdoor sports. Dom was a member

of his high school gymnastics team in Ottawa and a member of the University of Alberta’s Golden Bears

Gymnastics Team. As PVR’s owner, Dom’s vision is to encourage young athletes to excel in sports and to

promote lifelong physical activity. He will work closely with all staff to ensure that our campers receive

the best camp experience.

JACQUELINE LEFEBVRE: CAMP COORDINATOR

Jacquie has worked with children and medical services in various capacities for over 20 years. Her experiences include various positions at a Youth Horse Ranch including medic, and program coordinator; Emergency Medical Services Technician; In Home Respite Provider; Youth Camp Program Coordinator; Youth Camp Program Director; and Educational Assistant. Jacquie's strong background in youth work, administration, staff mentoring, volunteer recruitment, community services and crisis management will ensure that all of our campers receive a safe, fun with activities and memorable summer camp experience.

PAM KRIANGKUM: MARKETING

Pam was on the Canadian National Trampoline team and represented Canada in double-mini trampoline

at the Trampoline Gymnastics World Championships hosted in Bulgaria and the United States in 2013 and

2014, respectively. She is also a national level judge in trampoline and tumbling, and holds a Bachelor

Degree in Kinesiology. She is currently PVR’s Marketing Manager and also a professional photographer.

COACHES

KELLY MANJAK

Kelly is the head coach and owner of Manjak’s Gymnastics of Mississauga, Ontario. Kelly coached Kyle

Shewfelt to Canada’s First Olympic Gold Medal at the 2004 Olympic Games hosted in Athens, Greece.

Since then, Kelly has coached many gymnasts that have achieved Canadian National Team status and have

represented Canada at many major national and international competitions in both men’s and women’s

artistic gymnastics.

RICK McCHARLES

Rick is a gymnastics enthusiast who has dedicated over 40 years to the sport as a coach, mentor, and learning facilitator. Rick’s philosophy is to work hard and play hard, and that the sport of gymnastics can be a safe haven for athletes as they work towards their potential and goals through hard work, dedication, and of course – fun. Rick is an expert in recreational gymnastics and developmental gymnastics, and has been a principal developmental coach of a number of international gymnasts. Many of Rick’s former athletes have received scholarships to universities in Canada and the USA, and he was an FIG level Men’s Artistic judge for many years.

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TONY RETROSI

Tony Retrosi is the head coach and owner of Atlantic Gymnastics Training Center located in New Hampshire and is also the principal coach and founder of Gym-Momentum-Training-Camp. In 2010, he was celebrated as Educator of the Year by USA Gymnastics (USGA). Tony is a lecturer at state, regional, and national gymnastics congresses across the USA, and is also a guest clinician at training camps throughout North America, the Caribbean, Europe, and Australia. Tony has also instructed USGA Safety & Risk Management courses, and has lectured American university level gymnastic courses.

KRISTI CLOMAN

Kristi is the Women's Competitive Director at Capital City Gymnastics Centre in Edmonton, Alberta. She has been coaching for over 25 years and has coached many National Champions. She has also coached many gymnasts that have gone on to full NCAA scholarships in the US. She is a NCCP level 4 coach. Her goal is to help each athlete reach their full potential while fostering their love of the sport.

ANDREW VETTER

Andrew has been coaching for 9 years, and has been strictly working with WAG competitive athletes for

6 years. Andrew was an international competitor in both MAG and Trampoline & Tumbling, and has

attended 7 Canadian National Championships as an athlete. Andrew had a short-term career out of

performing in various circus acts, and he is the creator and choreographer of the viral fitness routine

“Uptown Abs”. Andrew is the current head coach at Gymtastics Gym Club in Calgary, Alberta.

ZOLTAN NAGY

Zoltan received Master’s Degree in Teacher of Physical Education and Adapted Physical Education from

Semmelweis University in Budapest, Hungary. He has coached at Bela Karolyi’s gymnastics camp during

the summers of 2005-2015 where he mostly worked with advanced WAG gymnasts on floor, tumble track,

uneven bars and vault. He was a gymnastics coach at Central Sport School in Budapest until 2015 before

joining the WAG coaching staff at Capital City Gymnastics Centre in Edmonton, Alberta.

In addition, Zoltan was a competitive Ballroom dancer in Hungary.

LIANG CHENG

Liang was a former All Around National Champion in MAG in China. He is the founder and President of

Inspire Sports Inc. Liang coached at Capital City Gymnastics Centre for over 20 years, 15 of which were as

the Men’s Program Director. Liang participated as a coach with the Canadian National Team to various

international competitions such as Universiade Games, Pan Am Games, Commonwealth Games, World

Cup Events, World Championships, and Olympic Games. Liang is a NCCP Level 4 coach in Canada and he

has also developed a similar NCCP program for China (RGCCP) and is a course conductor in RGCCP as well.

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MIGUEL COSTANTE

Miguel was a 2 time National Champion in MAG in Argentina. He has been involved in gymnastics for over 48 years and 44 years as a coach. Miguel came to Canada 25 years ago and had previously been the head coach at Mississauga Gym Centre and Ottawa Gym Centre. He is the current head coach at Capital City Gymnastics Centre in Edmonton, Alberta. Recently, Miguel was a gymnastics course conductor at RGCCP in Shanghai, China.

BOBBY KRIANGKUM

Bobby was an international competitor in MAG and represented Canada as a member of the Junior National Team until 2011. He became a member of Thailand’s Senior National Team and competed in four World Championships (2011 and 2013-2015), 2014 Asian Games in South Korea, and 2015 South East Asian Games in Singapore. Bobby holds Bachelor Degree in Commerce, currently is the Program Coordinator and coach at Pine Valley Gym Centre.

CELEBRITY GUESTS

SCOTT MORGAN

Scott made his international debut in 2011 at the Pan American Games in Guadalajara, Mexico and represented Canada again in 2015 when the Pan Am games were held in Toronto, Canada. In 2013, he was the first Canadian in 7 years to become 1 of 8 finalists at the Artistic Gymnastics World Championships in Antwerp, Belgium. Scott was Canada’s most decorated gymnast at the 2014 Commonwealth Games in Glasgow, Scotland where he captured silver on floor, gold on rings and vault, and a team bronze medal. Scott proudly represented Canada as the only MAG athlete at the 2016 Olympic Games in Rio de Janeiro, Brazil and competed on floor, vault, and rings; since then, he has been actively promoting gymnastics nationwide.

JACKSON PAYNE

Jackson has been a member of the Canadian Senior National Team in MAG since 2009. He is one of the

best all-around gymnasts in recent Canadian history, capturing an All-Around Canadian Championships

title in 2011, 2015, and 2016. Jackson represented Canada to 3 Pan Am Championships, 4 World

Championships, 2 Olympic Games Test Events, and many World Cup events. Jackson was also the alternate

for the 2016 Olympic Games in Rio de Janeiro, Brazil.

Jackson is currently studying Kinesiology at the University of Calgary.

WEEKLY SENIOR COACHES SCHEDULE

Week 1 WAG: Kelly Manjak, Andrew Vetter MAG: Kelly Manjak, Rick McCharles Week 2 WAG: Lisa Jeffries MAG: Miquel Costante, Scott Morgan Week 3 WAG: Zoltan Nagy MAG: Bobby Kriangkum Week 4 WAG: Tony Retrosi, Kristi Cloman MAG: Liang Cheng, Jackson Payne

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GYMNASTICS FACILITY

With over 12,500 sq.ft. facility, our gym features world class equipment through our partnership with Spieth America.

Qty Description Qty Description

1 40x40 Spring Floor 2 Uneven Bars

1 Still Rings 5 Balance Beam

2 Parallel Bars 2 Vault Table

2 Pommel Horse 1 Tumbling Track

2 High bars 2 In-Ground Trampoline

1 Adjustable High Bars/Uneven Bars Set 2 Foam Pit

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ACCOMMODATIONS

PVR lodge includes 96 beds with a combination of single and double bunk beds. Rooms with single-sized

bunk beds can sleep 8 people and rooms with double-sized bunk beds can sleep 2 people.

Our two-storey building is divided into 6 units. Each unit comprises multiple bedrooms, common area and

common bathroom. Boys and girls will be assigned to separate unit. At least one counselor will be staying

in each unit to ensure the comfort, safety, and enjoyment of our campers.

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The basement in the lodge has a large classroom that can be utilized for meetings and social gatherings.

There is also a theatre as well as a kitchen. A foosball table and shuffle board table are available in our

game room.

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DINING HALL

Our dining hall features dining area for 200 guests, a stage and sitting lounge/library with a wood burning

fireplace.

MEALS

To ensure the highest quality, all meals are prepared by our in-house chefs. Typical meal plan is outlined

as follows:

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TYPICAL CAMP MENU – JULY 2017

Sunday Monday Tuesday Wednesday Thursday Friday Saturday B

reak

fast

8

:00

am

– 9

:00

am

N/A

Fresh Fruits Yogurt Bagel Cold Cereal Oatmeal Poached Egg Scrambled Egg Bacon Sausages Waffle Pancake Toast Water, Milk Juice Tea, Coffee

Fresh Fruits Yogurt Bagel Cold Cereal Oatmeal Poached Egg Scrambled Egg Bacon Sausages Waffle Pancake Toast Water, Milk Juice Tea, Coffee

Fresh Fruits Yogurt Bagel Cold Cereal Oatmeal Poached Egg Scrambled Egg Bacon Sausages Waffle Pancake Toast Water, Milk Juice Tea, Coffee

Fresh Fruits Yogurt Bagel Cold Cereal Oatmeal Poached Egg Scrambled Egg Bacon Sausages Waffle Pancake Toast Water, Milk Juice Tea, Coffee

Fresh Fruits Yogurt Bagel Cold Cereal Oatmeal Poached Egg Scrambled Egg Bacon Sausages Waffle Pancake Toast Water, Milk Juice Tea, Coffee

Fresh Fruits Yogurt Bagel Cold Cereal Oatmeal Poached Egg Scrambled Egg Bacon Sausages Waffle Pancake Toast Water, Milk Juice Tea, Coffee

Lun

ch

12:

30

pm

– 1

:30

pm

N/A

Soup Salad Sandwich Grilled Cheese Cinnamon Bun Cookies Squares Fresh Fruits Water, Milk, Tea, Coffee

Soup Salad Wraps Pizza Cinnamon Bun Cookies Squares Fresh Fruits Water, Milk, Tea, Coffee

Soup Salad Hamburger Hotdog Chicken Finger Crispy Fries Cinnamon Bun Cookies Squares Fresh Fruits Water, Milk, Tea, Coffee

Soup Salad Sandwiches Pizza Cinnamon Bun Cookies Squares Fresh Fruits Water, Milk, Tea, Coffee

Soup Salad Chicken Fajitas Crispy Fries Cinnamon Bun Cookies Squares Fresh Fruits Water, Milk, Tea, Coffee

N/A

Din

ner

6

:00

pm

– 7

:00

pm

Soup Greek Salad Caesar Salad Baked Ham Roast Turkey Stuffing Mashed Potato Gravy Fresh Fruits Pie, Squares Water, Milk, Tea, Coffee

Soup Salad Spaghetti with Meat Sauce/ Marinara Sauce Garlic Toast Baked Chicken Fresh Fruits Cake, Cookies Water, Milk, Tea, Coffee

Soup Salad Roast Pork Lasagna Roasted Potato Steamed Vegetables Fresh Fruits Pie, Cookies Water, Milk, Tea, Coffee

Soup Salad Steak Fried Chicken Baked Bean Corn Fresh Fruits Pie, Cookies Water, Milk, Tea, Coffee

Soup Salad Spring Roll Steam rice Satay Chicken Sweet and Sour Pork Ice Cream Fresh fruits Pie, Squares Water, Milk, Tea, Coffee

Soup Salad Sausages, Sauerkraut Perogies Roast Beef Roasted Root Vegetables Mashed Potato Gravy Fresh Fruits Cake, Cookies Water, Milk, Tea, Coffee

N/A

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ADMINISTRATION AND GENERAL STORE

Camp registration and check-out will take place in the

Administration and General Store.

Merchandise such as apparel, souvenirs, gymnastics wear,

toiletries, food and drink are available at the General Store

for purchase. We accept cash, debit and credit card.

Additionally, an allowance card that can be used throughout

the week is available for campers to purchase online or

during check-in. The remaining credit on the card will be

refunded within 15 days at the end of the camp.

CAMP RATES

1 week training + meals + activities + single bunk bed (8 people/room): $900 + applicable taxes

1 week training + meals + activities + double bunk bed (2 people/room): $969 + applicable taxes

PLEASE NOTE THAT GYMNASTS ARE EXPECTED TO BRING THEIR OWN BEDDING.

Cancellations must be made before June 16, 2017 and will be subject to a $200 fee. Any cancellations

after this date will not be refunded.

REGISTRATION:

Online registration is available at WWW.PINEVALLEYGYMCENTRE.COM and requires credit card

payment. For other forms of payment, please contact us at info@pvralberta.com.

CONTACT INFORMATION

Our e-mail contact is info@pvralberta.com

Administration/General Store: (825) 845-2000

Pine Valley Gym Centre: (825) 845-2001

Pine Valley Lodge: (825) 845-2002

Pine Valley Dining Hall: (780) 698-3982

CHECK-IN & CHECK-OUT

Check-In: Sunday 1:00 pm - 2:00 pm.

Check-Out: Saturday 10:00 am - 12 noon.

The person picking up the camper must be listed on the Pick-Up Authorization Form.

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AIRPORT PICK-UP AND DROP-OFF

PVR can provide ground transportation from and to the Edmonton International Airport for an additional

fee.

For pick-up, our staff will be waiting at the gate upon the arrival of the campers and accompanying them

to baggage claim and bring them to PVR.

For the return flight, our staff will assist the campers in checking in and, upon request, accompany them

to the gate to ensure that they are safely on the plane to their destination.

Tentative pick-up time on Sunday: 9:00 am – 1:00 pm

Tentative drop-off time on Saturday: 11:00 am – 2:00 pm

Price per person: $50 one way or $100 return trip. All prices are subject to GST.

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RECOMMENDED CAMP PACKING LIST

GYMNASTIC GEAR

Water bottle

Normal gymnastics gear (tape, grips, braces, slippers)

Girls:

5 Gymsuits

Spandex Shorts

Boys:

5 Training Shirts

Shorts

BEDDING & LINENS

1 Pillow & Pillowcase

1 Sleeping bag

1 Extra blankets

2 Towels

CLOTHING

7 Shirts

5 Pants/Shorts

3 Sweaters/Hoodies

2 Sweatpants

Sleepwear

7 Underwear

7 Pairs of socks

1 Pairs of sandals

1 Pairs of running shoes

1 Rain jacket

1 Light jacket

1 Hat

TOILETRIES

Toothbrush

Toothpaste

Soap/Shower Gel

Shampoo/Conditioner

Brush/Comb

Hair products and accessories

(hair dryer, hair eleastics,

clips, etc.)

Deodorant

Sunscreen

Insect Repellent

DO NOT BRING

Cash or valuables

Electronics

(Tablets, cameras, phones, gaming

devices, etc.)

Chewing gum, candy, food*

*If you have severe food allergies,

please inform us prior to attending

camp.

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NOTIFICATION OF RISK, MEDICAL & EMERGENCY RELEASE AND WAIVER OF LIABILITY

PLEASE READ CAREFULLY

PARTICIPANT FIRST NAME: LAST NAME: GENDER DOB (yyyy-mm-dd):

ADDRESS: CITY PROVINCE POSTAL CODE

PARENT/GUARDIAN NAME: TELEPHONE: E-MAIL:

EMERGENCY CONTACT: EMERGENCY TELEPHONE:

FACILITIES NAME:

PINE VALLEY RESORT CO.LTD. / PINE VALLEY GYM CENTRE / DK CONSULTING SERVICES LTD. – referred to as PVR

ALBERTA FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT. (FOIP) By signing below, I consent to having the information in this document collected PVR. The personal information

requested on this form is collected under the authority of PVR and Section 33 © of the FOIP Act to allow

participation in programs. Certain personal information may be made available to federal and provincial

government departments and agencies under appropriate legislative authority. Personal information is protected

under the Alberta FOIP Act.

PHOTO/VIDEO RELEASE I acknowledge that PVR may take pictures or video of my child during their participation in any program, and that these may be used for advertising purposes. I agree to have my child’s picture and/or video used for advertising purposes (initials).

DESCRIPTION OF RISKS: I am aware that gymnastics, acrobatics, fitness and similar activities involve inherent risks, dangers and hazards that are associated with unique movement patterns and skills, which may, in some circumstances be executed on specialized apparatus. I acknowledge that personal harm or injury may be sustained during my/my child/children involvement in the activity, for example broken bones, head injuries, dislocations, tendon and ligament damage, damage to teeth and dental work, spinal injuries that could result in various degrees of paralysis or death. I acknowledge and assume the potential risks and consent to my/my child/children participation.

CONSENT OF PARTICIPATION: • I/my child have/has been informed that I/he/she is to abide by the rules and regulations including directions

and instructions from the administrators, instructors, and supervisors as imposed on me/my child/children while participating in the program.

• In the event that I/my child fails to abide by the rules and regulations imposed on me/my child/children while participating in the program, disciplinary action may either require that I/he/she not participate in the program or activity, or that I will leave/be contacted to have my child picked up or transported home at my own expense.

• I acknowledge that it is my responsibility to notify the staff of any physical or mental concerns for me/my child which may affect my/my child’s participation in the program.

• I acknowledge that the program may require an instructor to perform some manual spotting which involves direct physical contact with my child and designed to assist the participant in the safe performance of the program skills.

• Moreover, I understand that part of the camping experience involves group living arrangements and interactions that may be new to my child. This comes with certain psychological, emotional, mental and other physical risks and uncertainties, beyond what my child may be used to dealing with at home. I am aware of

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these risks, and I am assuming them on behalf of my child to the fullest extent permissible by law. I realize that no environment is risk-free, and so I have instructed my child on the importance of abiding by the camp's rules, regulations and policies, and my child and I both agree that he or she is familiar with these rules and obey them.

• I understand that my child will participate in a number of sports activities including but not limited to, swimming and miscellaneous water activities, hiking, mountain biking while attending the PVR Camp / Activities program. I understand that these activities will involve physical exertion by the child as well as contact with other children, with many of these activities taking place outdoors

• I understand that while attending the PVR Camp / Activities program, my child may be transported by Van or Bus to off site locations on days designated for Off Grounds Excursion. I grant permission for my child to

participate in any scheduled off-site trips.

WAIVER OF LIABILITY: I acknowledge that I have read the above description of risks and accept responsibility for my own actions/my child/children actions. I also acknowledge that I understand, appreciate and accept the physical risks associated with my participation in and/or in the PVR program, and that I have executed this understanding of risk agreement voluntarily.

In consideration of my/my child’s participation in the program with PVR with its inherent risks and hazards, I agree to:

• Waive and Release any and all claims against all liability for personal injury, death, property damage, or loss that I/my child may suffer, arising from any cause whatsoever, that I or my child may have now or in the future against PVR, their elected directors and officers, employees, agents, volunteers, and representatives, or any of them in connection or participation within the program.

MEDICAL EMERGENCY: I hereby authorize basic first aid to be delivered to me/my child by the club staff or other authorities. By administering first aid when required or requested, PVR in no way warrants or assumes any liability in relation to the administration of such basic first aid.

I further understand and agree that, in the case of an emergency; PVR assume no responsibility or obligation relative to any cost or expense related to carrying out an emergency procedure and/or emergency transportation for me/my child and I agree to pay for such costs and expenses and shall indemnify and reimburse PVR for any such costs or expenses that it incurs.

I CONFIRM THAT I HAVE READ, COMPLETED AND UNDERSTAND THIS LEGAL AGREEMENT, I AGREE TO BE

BOUND BY ITS TERMS, AND I AM AWARE THAT BY SIGING THIS AGREEMENT I AM WAIVING CERTAIN

LEGAL RIGHTS AGAINST PVR.

Signed this day of , 20 at ______________________________________

Signature of Participant (if over 18 years of age) Signature of Witness

Signature of Parent or Guardian (as named above) Signature of Witness