Parent or Guardian First & Last Name:
Participant Last Name (if different):
Mailing Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:

Participant's First Name Age Shirt Size Program Title Fee

By clicking the button below, you certify that you have read and fully understand the warning or risk, and assumption of risk and waiver and release of all claims, shown here. You also certify that are 18 years or older, or are the Parent/Guardian of the participant(s).
Clicking this buttons acts as your signature!

Payment is due at the first program meeting.