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Camper Registration

First Name:
Last Name:
Address:
Email:
Phone Number:
Level:
9th - 12th  6th - 8th
if 9th - 12th:
if 6th - 8th:
City:
State:
Zip:
Date of Birth:
(mm/dd/yyyy)
Grade in Fall 2008:

This is a legally binding release for the above named minor child (hereinafter referred to as "Participant") executed by the above named Parent/Guardian to Molten Volleyball Camps, WI PoWer, Club Fusion Inc., and Molten Inc. (hereinafter referred to as MVC). In this agreement, the term "I" and "Undersigned" refer to the Participant's parent/guardian.

1.0 The Undersigned hereby grants permission to Participant toparticipate in the Molten Volleyball Camps being held the summer of 2008("Activity").

2.0 In consideration of the Participant being permitted to participate in the Activity, the Undersigned releases MVC (and its employees and agents) from any and all liability, claims and actions not arising from MVC's causal negligence, that may arise from injury or harm to the Participant or from loss or damage to any property belonging to the Undersigned in connection with this Activity. The Undersigned grants permission despite the possible dangers and risks, and despite this Release. The Undersigned understands that MVC does not require Participant to take part in the Activity.

3.0 Undersigned therefore agrees to assume and take on all of the risks, except for those risks specifically created by the causal negligence of MVC, in any way associated with the Activity.

The Undersigned also understands that this Release binds heirs, executors, administrators, and assignees of the Participant.

I have read this entire RELEASE; I fully understand it and I agree to be legally bound by its terms.


Parent/Guardian Signature Date

Please indicate any allergies Participant has to medications or food. Please indicate any previous injuries or medical conditions MVC should be aware of.

Allergies:
Injuries: