Adventure Club

Club Member First and Last

Address

Phone Number

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T-Shirt Size

Height (life jacket purposes)

Weight (life jacket purposes)

Gender

Male
Female

Age:

Date of Birth

Parent First and Last

Emergency Contact

Emergency Contact Phone Number

Relationship to Club Member

Names of Persons Allowed to Pick Up Club Member (PLEASE LIST ALL ALLOWED NAMES INCLUDING PARENT/GUARDIAN)

Health Concerns-Does the participant have any special medical needs, physical limitations or health concerns we should be aware of? (Please list below)

How did you hear about us?

Terms and Conditions

Adventure Mystic LLC Terms and Conditions of Participation
Responsibilities- Adventure Mystic LLC provided instruction, equipment and facilities to conduct Adventure Camp to which these terms & conditions apply.
Conduct by Participant- If it is determined by Adventure Mystic LLC personnel that the program participant is acting in a manner which is illegal or which interferes with the rights, safety and enjoyment of other participants, then he/she may be immediately expelled from the program without refund from Adventure Mystic LLC.
Additional Responsibilities:
1. Payments are non-refundable and on-transferable-participants who cancel at least 7 days before the requested summer session will receive full refund minus a $25 processing fee.
2. The price quoted you includes instruction and supervision Adventure Mystic LLC reserves the right to pass through any actual increases in the cost of these components that occur before the completion of the 2024 season.
3. Participants must have medical and hospital insurance in effect throughout the program that will cover any such expenses.
4. Participants possessions are his/her responsibility. Adventure Mystic LLC or "Owner" is not responsible for mislaid, damaged, lost or stolen articles of personal property.
5. The above-named Adventure Mystic LLC participant and his/her legal representatives assigns the irrevocable and unrestricted right to use and publish photographs of the above-named Adventure Mystic LLC participant, or in which Adventure Mystic LLC participant may be included, for and any other purpose and editorial, trade, advertising and any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same. Photographer and his/her legal representatives assign from all claims and liability relating to said photographs.

I, the undersigned, agree to the terms above.

Running Total

$0.00

Tax

$18.07

Coupon Code

Total

$19.27

Includes $1.81 of processing & fees

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Registration Summary:	Total
Registrants (x1)	$17.46
Processing & Fees Fees include credit card processing fees and third-party software fees	$1.81

Total

$19.27

Includes processing & fees

Billing Information

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