CAMP PENDLETON C.A.M.O SUMMER FIT CAMP CAMP DATES: JULY 11 - JULY 14, 2011 REGISTRATION FEE: $20.

00 PER CHILD, $10.00 FOR EACH ADDITIONAL SIBLING CAMP AGE RANGE: 7 - 11 YEARS OF AGE
Your registration fee of $20.00 includes: Supplies and lunch for your child.

CHILD'S FULL NAME: PARENTS' NAME: ADDRESS: TELEPHONE: (

PERSONAL INFORMATION

GENDER: CITY/ZIP: E-MAIL:

MALE

FEMALE

SPONSOR RANK/UNIT:

SPONSOR WORK PHONE: SPOUSE WORK PHONE: EMERGENCY NAME AND PHONE (OTHER THAN ABOVE): AGE DIVISION DATE OF BIRTH: YS YM AGE AS OF JULY 11, 2011: T-SHIRT SIZES- Please indicate what size your child will need YL AS AM AL HOLD HARMLESS AGREEMENT/MEDICAL RELEASE/PHOTO RELEASE

The parent or Guardian and minor fully understands that there may be some inherent risk involved in the Event/Activity in which the minor desires to participate in. Participation is voluntary and the Parent or Guardian agrees to assume the risk of personal injury for the minor. In addition, the Parent or Guardian agrees to indemnify and hold harmless the United States Marine Corps and Marine Corps Community Services (MCCS), its officers, employees, successors, and assigns from and against any and all claims, damages, liability, losses including reasonable attorneys fees and cost of suit, arising out of the minors participation in an MCCS Event/Activity. By signing of the agreement, the Parent or Guardian and minor certifies that they fully understand the risks and dangers involved in the Event/Activity. In the case of injury, the Parent or Guardian grants consent for the minor to receive emergency medical treatment.

I give my express permission and consent for MCCS, Camp Pendleton , California, to copy, reprint and otherwise utilize photographs and videos taken of my child at Paige Fieldhouse on July 11-14, 2011 that include my childs likeness and also my childs identity by name for purposes of commercial purposes. I agree that such use of my childs photographs, videos and likeness will not constitute an invasion of privacy or unauthorized commercial use of my childs name, photograph or likeness under the laws of the State of California. Print your name: _________________________________________ Parent Signature:_________________________________________ Special Medical Consideration (e.g., allergy, medication):____________________________
Please make check payable to MCCS 0140 (CASH, CHECK OR MONEY ORDERS ACCEPTED)

Comments: **FOR OFFICIAL USE**

Receipt # ____________________ Location of Registration: ____________ Date received:___________ Initials: _______