2015 Riverview Sports Camp

2015 Riverview Sports Camp PARKOUR & BREAKDANCING JULY 6 - JULY 10, 2015 **REGISTRATION DUE BY: June 12, 2015**

Name:______Male ( ) Female ( )

DOB:______Phone:______

E-Mail (required for receipt):______

T-Shirt Size: Adult ( ) Child ( ) SIZE:______

RELEASE AND ARBITRATION AGREEMENT-RIVERVIEW SPORTS CAMP

ARRIVAL: 07/6/15 2:00PM DEPARTURE: 07/10/15 11:00AM In consideration of RIVERVIEW BIBLE CAMP, I for myself, or the minor child named below, forever waive, release and discharge RIVERVIEW BIBLE CAMP (and its parent corporation) from any/all injuries, claims, disputes, liabilities, or actions resulting from RIVERVIEW BIBLE CAMP providing services for me and for my benefit regardless of location for the dates identified above, except for injury or damage arising out of RIVERVIEW BIBLE CAMP’S, negligence or willful misconduct. I attest and verify that I have full knowledge of the risks and dangers involved; that I assume such risks, and that I will assume and pay my own medical and emergency expenses, in the event of an accident, illness or other incapacity, regardless of whether I have authorized such expenses.

Any controversy arising out of, connected to, or relating to any matters herein of the transactions between me and the above named parties or on behalf of the minor child named below, of this Release/Waiver, or the breach thereof, including but not limited to any claims of violations of Federal and/or State Law, as well as any common law claims shall be settled by arbitration through Christian Conciliation Services; and in accordance with this paragraph a judgment based upon the arbitrator’s award may be entered in any court having jurisdiction thereof in accordance with the provisions of R.C.W.7.04. This agreement shall be construed and interpreted under the laws of the State of Washington. I HAVE READ THIS WAIVER AND RELEASE CAREFULLY, AND UNDERSTAND IT. RELEASE INDEMNITY-ACADEMY OF SHOTOKAN MARTIAL ARTS I, intending to be legally bound, do hereby release Rick Montgomery, staff and instructors, from any claims, liabilities, obligations, and causes of action or demands. I, intending to be legally bound, do agree to indemnity said Rick Montgomery, staff and instructors, from any act committed during or arising out of or arising out of or as the result of any activity presented by Rick Montgomery. I, further release Rick Montgomery, staff and instructors, from all claims of liability for any property or valuables lost, mislaid or stolen. I give permission to Rick Montgomery, staff and instructors, to hospitalize and/or secure treatment for any medical issue or injury. This includes giving permission to exchange, written or orally, any information concerning any injury, illness, or medical history to medial personnel, as needed for emergency medical care. I have read the foregoing and fully understand the contents of this release indemnity. I agree to the payment option I have checked below and assume full financial responsibility.

X Print Participant’s Name Birthdate: MO/ DAY/ YEAR

X______Date:______Signature (Parent/Guardian if participant named above is under 18)

In case of emergency notify:______Phone:______

Please list any pertinent medical history (example: asthma, heart, diabetic, allergies-including bee stings/food):

______

Payment Enclosed: ( ) Paid in full $325 (Subtract $25 EARLY BIRD SPECIAL if registering prior to March 1, 2015) ( ) $100 Deposit-guarantees camper’s spot (Remaining balance due June 12, 2015) **Payment Options: 1) Pay in Full. EARLY BIRD SPECIAL: Subtract $25 if registering prior to March 1, 2015. 2) A $100 Non-refundable deposit to hold camper’s spot. Remaining balance is due by June 12, 2015. EARLY BIRD SPECIAL: If your $100 Non-refundable deposit is received prior to March 1, 2015, you will receive a $25 discount on your remaining balance.

** Registration Process : Please send registration form, concussion form and check/money order made out to:

David Moyle 2417 E. South Crescent Spokane, WA. 99207

**Once your check has cleared you will receive a receipt via e-mail**

**Cancellation/Refund Policy: Our refund policy is: For campers that have paid in full, only $200 of your payment is refundable if a request is received in writing prior to June 12, 2015. For all campers, after June 12, 2015, a $200 refund will only be granted with a medical note signed by a physician. For all campers, refunds during camp secondary to injury, illness or any other issues will not be granted.

**Returned Check Policy: If a check is returned for any reason, a $25.00 charge will be assessed. The camper will then not be allowed to participate until full CASH payment is received.

~Directions to Riverview Bible Camp from Spokane, WA.~ Head north on Division Street towards the "Y". Take the slight right turn onto US-2 E. Go 28.4 miles where you'll turn left onto WA- 211 N. Go 15.2 miles and turn left onto State Route 20 W/WA-20 W. Go 12.7 miles and Riverview Bible Camp will be on your right.

RIVERVIEW BIBLE CAMP 408771 State Route 20 Cusick, WA. 99119