Leadership and Mindset Camp RegistrationCamp Date: October 18thLocation: Dodgeville Middle School Gymnasium4th – 6th grade – 10am – 11:30am; 7th and 8th grade – 12pm – 2pmPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Parent Name *FirstLastParent Email *Parent Cell Phone *City, StateChild Name 1 *FirstLastChild 1 Grade *T Shirt Size (Child 1) *SelectYMYLYXLASAMALAXLChild Name 2FirstLastChild 2 Grade Risk Child Email T Shirt Size (Child 2)SelectYMYLYXLASAMALAXLWaiver of Liability and Assumption of Risk *I have read and agree to the Waiver & ReleaseBy registering for and participating in the Athlete Leadership and Mindset Camp (“Camp”), I acknowledge and agree to the following:Assumption of Risk: I understand that participation in physical activities, games, and drills involves inherent risks of injury. I voluntarily assume all risks, known and unknown, including but not limited to sprains, strains, falls, or other injuries.Release of Liability: I hereby release, discharge, and hold harmless Ball to Life, its staff, volunteers, sponsors, and affiliates from any and all liability, claims, or demands arising from participation in the Camp, whether caused by negligence or otherwise, to the fullest extent permitted by law.Medical Authorization: In the event of an emergency, I authorize Ball to Life staff to secure necessary medical treatment for my child at my expense.Parental/Guardian Consent (if under 18): I am the parent or legal guardian of the participant and consent to their participation. I have explained the risks of participation to my child and accept responsibility for their involvement.Photography/Media Release: I grant permission for photos or videos taken during the Camp to be used for program promotion, unless I provide written notice otherwise.By checking the box and submitting this form, I confirm that I have read, understood, and agree to this Waiver & Release.Electronic Signature Agreement *Acknowledgement of Electronic SignatureBy typing my full name below, I acknowledge that this electronic entry is the legal equivalent of my handwritten signature. I agree to the terms of the Waiver & Release stated above and confirm my consent for participation in the Athlete Leadership and Mindset Camp.Signature of Parent/Guardian *Number of Athletes Registering *— Select Choice —OneTwoTotal$0.00Payment Information *Submit