- - - - - - - - - - - - - - - - - - - - - - - - - John H. Shary Summer Chess Camp Registration Form - - - - - - - - - - - - - - - - - - - - - - - - - - Campers Full Name: ___________________________________________________ Male _______ Female _______ Date of Birth: _____________________ Age during camp: _______ Phone number: _____________________________ Address: _______________________________________ City: _________________ State: _______ Zip:_____________ School: ________________________________________ Grade:_______ USCF# (if any)_________________________ Waivers and Informed Consent: By signing this form, I, as parent/guardian, permit Dark Knights Chess and Sharyland ISD to use pictures of my child as a program participant in promotional literature, videos, and the Dark Knights Chess / Sharyland ISD websites. I understand my child’s name will not be published. I, as parent/guardian of ______________________________ (“Child”), hereby assume all risks and hazards incidental to the conduct of the activities at the chess camp. My Child is fit for the camp in which I have enrolled him/her. I HERELY RELEASE AND SHALL DEFEND, INDEMNIFY AND HOLD HARMLESS RELEASEES FROM EVERY CLAIM AND ANY LIABILITY THAT I OR MY CHILD MAY ALLEGE AGAINST RELEASEES (including reasonable legal fees and costs) AS A DIRECT OR INDIRECT RESULT OF INJURY OR DEATH TO ME OR MY CHILD BECAUSE OF MY CHILD’S PARTITIPATION IN ANY DARK KNIGHTS CHESS / SHARYLAND ISD CAMP , WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES OR OTHERS TO THE MAXIMUM EXTENT PERMITTED BY LAW. I PROMISE NOT TO SUE RELEASEES ON MY BEHALF OR ON BEHALF OF MY CHILD REGARDING ANY CLAIM ARISING FROM OR RELATED TO MY CHILD’S PARTICIPATION IN ANY DARK KNIGHTS CHESS / SHARYLAND ISD CAMP. I ACKNOWLEDGE THAT, BY SIGNING THIS DOCUMENT, I AM RELEASING DARK KNIGHTS CHESS, SHARLAND ISD, AND THEIR REPRESENTATIVES, AGENTS, EMPLOYEES, VOLUNTEERS, MEMBERS, SPONSORS, PROMOTERS, AND AFFILIATES (COLLECTIVELY “RELEASEES”) FROM LIABILITY, AND THAT I AM GIVING UP SUBSTANTIAL LEGAL RIGHTS. THIS SIGN UP AND RELEASE FORM IS A CONTRACT WITH LEGAL AND BINDING CONSEQUENCES AND IT APPLIES TO ALL ACTIVITIES IN WHICH MY CHILD ENGAGES DURING THE CHESS CAMP AT SHARYLAND ISD, REGARDLESS OF WHETHER SUCH ACTIVITY IS A PART OF A FORMAL PROGRAM. I HAVE READ THIS RELEASE CAREFULLY BEFORE SIGNING. I UNDERSTAND WHAT THIS RELEASE MEANS AND WHAT I AM AGREEING TO BY SIGNING. By registering for this program, I understand and agree that if a portion of the program is unable to be completed due to unforeseen circumstances under responsibility of Dark Knights Chess / Sharyland ISD, I will receive a prorated credit for the uncompleted portion of the program. I also understand that no refunds or proration will be given for any other reason. Signature: _____________________________________ Date: __________________________ Parent / Guardian Printed Name: ____________________________________ _______ Parent ______ Guardian Parent Email: ______________________________________ Registration Fee: $65.00/$75.00 for 1 week Cash _____ Check_____ PayPal _____ Date Paid: ______________ PLEASE MAKE ALL CHECKS PAYABLE TO: Dark Knights Chess Pre-Registration Deadline: Friday, June 15, 2018 06/18 06/22 65.00 dkchess.com/OLReg.html

Summer Chess Shary ISD 2018 Flyer - 0201.nccdn.net · the chess camp at sharyland isd, regardless of whether such activity is a part of a formal program. i have read this release

Download PDF Report

Upload
nguyenduong
View
221
Download
0

Embed Size (px)

Citation preview

Page 1: Summer Chess Shary ISD 2018 Flyer - 0201.nccdn.net · the chess camp at sharyland isd, regardless of whether such activity is a part of a formal program. i have read this release

-------------------------JohnH.SharySummerChessCampRegistrationForm--------------------------

CampersFullName:___________________________________________________Male_______Female_______

DateofBirth:_____________________Ageduringcamp:_______Phonenumber:_____________________________

Address:_______________________________________City:_________________State:_______Zip:_____________

School:________________________________________Grade:_______USCF#(ifany)_________________________

WaiversandInformedConsent:Bysigningthisform,I,asparent/guardian,permitDarkKnightsChessandSharylandISDtousepicturesofmychildasaprogramparticipantinpromotionalliterature,videos,andtheDarkKnightsChess/SharylandISDwebsites.Iunderstandmychild’snamewillnotbepublished.I,asparent/guardianof______________________________(“Child”),herebyassumeallrisksandhazardsincidentaltotheconductoftheactivitiesatthechesscamp.MyChildisfitforthecampinwhichIhaveenrolledhim/her.IHERELYRELEASEANDSHALLDEFEND,INDEMNIFYANDHOLDHARMLESSRELEASEESFROMEVERYCLAIMANDANYLIABILITYTHATIORMYCHILDMAYALLEGEAGAINSTRELEASEES(includingreasonablelegalfeesandcosts)ASADIRECTORINDIRECTRESULTOFINJURYORDEATHTOMEORMYCHILDBECAUSEOFMYCHILD’SPARTITIPATIONINANYDARKKNIGHTSCHESS/SHARYLANDISDCAMP,WHETHERCAUSEDBYTHENEGLIGENCEOFRELEASEESOROTHERSTOTHEMAXIMUMEXTENTPERMITTEDBYLAW.IPROMISENOTTOSUERELEASEESONMYBEHALFORONBEHALFOFMYCHILDREGARDINGANYCLAIMARISINGFROMORRELATEDTOMYCHILD’SPARTICIPATIONINANYDARKKNIGHTSCHESS/SHARYLANDISDCAMP.IACKNOWLEDGETHAT,BYSIGNINGTHISDOCUMENT,IAMRELEASINGDARKKNIGHTSCHESS,SHARLANDISD,ANDTHEIRREPRESENTATIVES,AGENTS,EMPLOYEES,VOLUNTEERS,MEMBERS,SPONSORS,PROMOTERS,ANDAFFILIATES(COLLECTIVELY“RELEASEES”)FROMLIABILITY,ANDTHATIAMGIVINGUPSUBSTANTIALLEGALRIGHTS.THISSIGNUPANDRELEASEFORMISACONTRACTWITHLEGALANDBINDINGCONSEQUENCESANDITAPPLIESTOALLACTIVITIESINWHICHMYCHILDENGAGESDURINGTHECHESSCAMPATSHARYLANDISD,REGARDLESSOFWHETHERSUCHACTIVITYISAPARTOFAFORMALPROGRAM.IHAVEREADTHISRELEASECAREFULLYBEFORESIGNING.IUNDERSTANDWHATTHISRELEASEMEANSANDWHATIAMAGREEINGTOBYSIGNING.Byregisteringforthisprogram,IunderstandandagreethatifaportionoftheprogramisunabletobecompletedduetounforeseencircumstancesunderresponsibilityofDarkKnightsChess/SharylandISD,Iwillreceiveaproratedcreditfortheuncompletedportionoftheprogram.Ialsounderstandthatnorefundsorprorationwillbegivenforanyotherreason.

Signature:_____________________________________Date:__________________________

Parent/GuardianPrintedName:___________________________________________Parent______Guardian

ParentEmail:______________________________________

RegistrationFee:$65.00/$75.00for1weekCash_____Check_____PayPal_____DatePaid:______________

PLEASEMAKEALLCHECKSPAYABLETO:DarkKnightsChessPre-RegistrationDeadline:Friday,June15,2018

06/1806/22

65.00

dkchess.com/OLReg.html