Registration Form 

 

                                                      

                  Please complete and return this form with a *$100 deposit to:

          Portland Fencing Center 90 Bridge Street Site 410 Westbrook ME  04092       

 

Campers Name __________________________________Age_____ Gender ________

 

Street Address _____________________________________________________

 

City, State, Zip ______________________________________________________

 

Home Telephone ________________ Email _______________________________

 

R  Handed ___ L Handed ____

 

Session I (age 8-10) ______    Session II (age 10-12) ______      Session III (age 10 -12) ______

    July 21 - 25                         July 28 - August 1                           August 11 - 15                             

 

 

In consideration of my child’s acceptance into the Portland Fencing Center’s summer day camp, I, as parent

or legal guardian of ______________________________________, do hereby agree to waive all liability

of the Portland Fencing Center and its staff for any accidental injury, illness or other mishap that might befall

the above named day camper while traveling to or from or during his/her attendance and participation at the

Portland Fencing Center’s summer day camp.

 

 

_________________________________ Date ________________________

Parent or legal guardian’s signature

 

 Day Contact _______________________________ Phone _____________________

 

Secondary Contact __________________________  Phone _____________________

 

Camp size is limited to 10 Campers per session so please mail your completed registration form and the

non-refundable $100 deposit early.  Checks should be made payable to Portland Fencing Center and the

balance of the tuition is due July 1st for all sessions.  All fencing equipment is supplied and further camp details

will be E-mailed two weeks prior to camp. For Summer Champs campers your $100 deposit will be held

un-cashed and returned to you on the first day of camp.

 

 

 

We acknowledge that our child is physically and mentally capable of engaging in physical activity. 

 

Please list:

 

Any medical conditions of the camper, (allergies, asthma, disorders, etc)

 

 

 

 

Any past athletic injuries:

 

 

 

 

 

Thank you,

Nancy Reynolds

 

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