Superhero Movement Camp For boys and girls 3-5 years old.

May 29- June 1

9:00 am – 1:00 pm

Enjoy activities to improve large motor skills, speed,

and quickness.

Tumbling activities will also be included.

We will focus on a different activity each day, and

make a coordinating craft.

Cost $140

Email tinacguthrie@gmail.com with questions.

Superhero Movement Camp

May 29 – June 1 9:00 am – 1:00 pm

Students must be 3 years old by March 1, 2018

Student Name____________________________________________________ Age__________ Parents____________________________________________________________ Phone__________________Address___________________________________________________ City_____________________Zip____________ Email__________________________________________ Cell Phone________________________ Food Allergies______________________________________________ Please make checks payable to Tina Guthrie $140.00 due at registration Amount Paid_________ Check #_____________

Medical Release On behalf of my child, the above registered participant in the Olympics Camp, I (undersigned) hereby acknowledge that I understand the risks associated with Movement and Tumbling. Based upon this understanding, I do hereby forever release and discharge Tina Guthrie., it’s representatives, officers, employees, directors, assigns, successors, and heirs from and against any and all liability of whatever nature of kind resulting from an injury associated with the use or in the participation of any Movement and Tumbling activity. I (undersigned) have consulted with reliable medical authorities about any conditions, limitations, medications, and prior injuries for the above registered participant in the Olympics Camp., and assert that these do not constitute a barrier to my child’s participation in this program. I request and grant permission to teachers and other officials of this program to provide reasonable care to my child in the event of injury or illness during any activity if I am not present. I agree to accept the financial liabilities resulting from such care. I hereby give my permission for photographs of my child to be used for church purposes. Signature of Parent/Guardian____________________________________________ Date _________________________________________ Name of Emergency Contact (other than self)_____________________________________________ Relationship___________________________________ Phone______________________________________

Photo Release OlympicsCamprequestyourpermissiontophotographorvideoyourchildduringthesession.Photosand/orvideoswillbeusedforpossiblepromotionalmaterialsfortheMovementandTumblingprogramandtheChurchwebsite.Pleasesigntograntyourpermissiontophotographand/orvideoyourchild.Signatureofparent/guardian___________________________________________________________Date_______________________Phone_____________________