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Sports Camp Registration

Sports Camp Registration Form

First Name *
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *

Please send $100 registration fee by May 14, 2021 to:

ATTN Jeff Kirchmann
430 N Monitor St.
West Point, NE 68788

OR

Bring check to Rehab Department

Make checks payable to Franciscan Healthcare.

Waiver & Release
I hereby waive and release any and all claims, demands, and causes of action which I may have, or anyone may have through me against Franciscan Healthcare Rehabilitation, and/or school for any injuries that I may incur arising out in any way at the school during the following dates of June 1, 2021 through July 9, 2021. I further understand and acknowledge that neither Franciscan Healthcare Rehabilitation nor the school shall have any responsibility or liability for lost, damaged, or stolen personal property. I hereby grant Franciscan Healthcare the right and authority to photograph, film and/or record me vocally. These records may be used for promotional or publicity purposes and may be published in mass media publications, on the Franciscan Healthcare intranet or internet sites, or shown on television or movie presentations. The participant's and family's name may be used. This release is effective until revoked in writing by the undersigned.
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