Private Team Camps Registration

Coach's/Coordinator's Name*

First Last

Email*

Enter Email Confirm Email

Camp Location Name

Camp Location Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone*

Work Phone

Starting date of your workshop*

Length of Workshop*

Name of hotel you have reserved for you (leave blank if unknown)

Needed for the night before the camp and the second to last day...we will fly out on the final day. PS - ALL hotels require you to pre-pay at the counter in person and reserving a room over the phone does not guarantee the room for us.

Hotel Phone Number

Nearest Airport*

Is this a workshop for your team only, or is it open to outsiders?*

Who will be paying for the kids attending the camp?*

By typing my name below, I agree to the workshop for the set date. Remaining balance is due on the last day of camp.*

Release, Waiver and Indemnity, I agree, on behalf of my club / team / school / athletic affiliation / facility owner / operator, to release, waive, discharge and covenant not to sue Purler® and the camp and their respective owners, officers, directors, employees, staff, volunteers and agents (the “Releasees”) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage or injury, including death (each, a “Loss”), that may be sustained by me or the athlete or to any property belonging to any of us, while participating in camp activities or while at the Purler® facilities or the camp, REGARDLESS OF WHETHER SUCH LOSS IS CAUSE BY THE NEGLIGENCE OF ANY OF THE RELEASEES or otherwise, and regardless of whether such liability arises in tort, contract, strict liability or otherwise, to the fullest extent allowed by law. I further agree to exonerate, save, indemnify, and hold harmless the Releasees from any and all Losses of any kind and nature whatsoever which may arise from or in connection with the athletes’ conduct at the camp and his or her participation in any camp activities including, without limitation, personal injury, and any breach of this agreement by me or the athletes. It is my express intent that this agreement shall bind the members of my family and spouse, if any, and my heirs, assigns and personal representatives and shall be deemed as a release, waiver, discharge and covenant not to sue the above-named Releasees. In signing this agreement, I acknowledge and represent that I have read this agreement, understand it and sign it voluntarily as my own free act and deed, I am at least eighteen years of age and fully competent, and I execute this agreement for full, adequate and complete consideration fully intending to be bound by the same. Further, I have reviewed this agreement with my club / team / school / athletic affiliation / facility owner / operator, and he or she or they fully understand and agrees to follow all of the terms of this agreement while attending the camp that I / we are hosting and that Purler® is instructing. I further acknowledge that I am responsible for providing insurance for our camp, and that Purler® is merely providing the instruction for us and holds no responsibility for insuring our camp, staff, facilities, athletes, athlete’s parents / guardians, families, or visitors who attend our camp. All information I have provided to Purler® in the camp application or otherwise is accurate and complete.

Release, Waiver and Indemnity Acceptance*

I Accept

Camp Deposit Fee*

Total

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

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