JAMZ 2017|SAN DIEGO POP WARNER CHEER & DANCE CAMP EVENT DETAILS WHEN:

Sunday, August 20, 2017

CAMP SCHEDULE:

Jr PeeWee/ PeeWee/ Jr Midget/ Midget  Coach Check in: 8:30am  Camp Instruction: 9:30pm - 4:30pm  Lunch: 12:30 - 1:15pm

Tiny Mite & Mighty Mite

 Coach Check in: 12:30pm  Camp Instruction: 1:15pm - 4:30pm  No Lunch Break for TM & MM

Family & Friends Show: 4:00pm - 4:30pm

WHERE:

Abraham Lincoln High School 4777 Imperial Ave San Diego, CA 92113

COST:

Jr PeeWee/ PeeWee/ Jr Midget/ Midget - $40.00 Tiny Mite & Mighty Mite - $25.00

Coaches - FREE with team registration

WHAT’S INCLUDED Full Curriculum Excellent Staff-to-Student Ratio Top-rated Experts Specialized in All Levels Coaching Techniques & Unity Building Comprehensive Stunt Training New Stunt Building Techniques Game Day Material Dance Routines with a Variety of Styles (i.e. Funk, Hip-Hop, Pom, Novelty, Jazz)  Daily Awards & Fun Contests        

WHAT TO BRING  Water Bottle  Sunscreen  Spending Cash for Camp T-Shirts, Shorts & Fun Stuff  Comfortable Athletic Shoes  Have Hair Pulled Back Away from the Face & Shoulders  Form-Fitting Athletic Clothing (loose/baggy clothes are a stunt safety hazard)  Lunch OR cash for the Snack Bar!

HOW TO REGISTER 1) Complete the following forms (see additional pages):  Team Registration Form  Team Agreement of Compliance Form.  Jr. Coach/Underage Coach Agreement of Compliance Form 2) Submit all forms at the same time and one team payment using an option below: Option 1: Mail Checks (no personal checks) and all required forms to: JAMZ Summer Camps | P.O. Box 4308, Modesto, CA 95352 Option 2: Fax all required forms and credit card form to 209-578-1617. Option 3: Email all required forms and credit card form to [email protected]. Camp tuition and registration are due in the JAMZ Office by: Monday, August 7, 2017 Payment must be made with registration forms. QUESTIONS? Call us or email [email protected].

TEAM REGISTRATION FORM

2017 SDPW JAMZ SUMMER CAMP MAIL this form (with payment) to: JAMZ SUMMER CAMPS: P.O. BOX 4308, MODESTO, CA 95352, EMAIL forms to [email protected] or FAX forms to: (209) 578-1617. ALL REGISTRATION & PAYMENT DUE: Monday, August 7, 2017. REMINDER: Agreement of Compliance Forms are required to participate at camp. Forms can be mailed, faxed, or turned in at coach check-in prior to the start of the first day of camp.

Camp Dates: August 20, 2017

Camp Location: Abraham Lincoln High School, 4777 Imperial Ave., San Diego, CA 92113 Team/Organization: ____________________________________________________ Team Type (check only one box):  Stunt and Dance

Level: _________________________________________________________________ (i.e. Mascot, Jr. Pee Wee, Varsity, Gremlin)

 Dance Only (no stunt) - If “Dance Only” selected check all that apply:  CheerStyle  Pom  Hip Hop/Funk

All correspondence will be forwarded to the contact person listed below: Coach’s/Coordinator’s/Advisor’s First Name____________________________________________

Last Name: __________________________________________________

Address: ____________________________________________________________________ City: ________________________________ State: _______ Zip: ____________ Home Phone: (

) ____________________________

Work Phone: (

) _______________________________ Cell Phone: (

) ____________________________

Email Address: ____________________________________________________________________________________ Additional Contact Person: __________________________________________________________________________

Phone: (

) _______________________________

Please complete the fields below. Names of individuals participating are required. Make additional copies as needed.

PARTICIPANT NAMES

FIRST NAME





LAST NAME

PARTICIPANT TYPE

Female

Male

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o

o

2

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o

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4

o

o

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o

o

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o

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o

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o

o

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o

My signature below indicates that I have read and agree with JAMZ’ Policies and Procedures. I am responsible for communicating this info to my coaching staff, parents and participants. Signature: _____________________________________________________________________________________________________________________________________



Total # of JPW/PW/JM/M Participants:

_____________________ multiplied by $



Total # of TM & MM Participants: TOTAL PARTICIPANTS :

_____________________ multiplied by $ _____________________

40.00 25.00

(Tuition per Participant)

= $ ___________________

(Tuition per Participant) = $ ___________________ TOTAL AMOUNT = $ ___________________

FOR OFFICE USE ONLY: DR ______________ DE ____________ MOP _______________ IP _______________ CFM _______________

ORGANIZATION/TEAM NAME: SIGNATURE:

MAIN CONTACT:

Medical Treatment, Liability Release, & Appearance Agreement for JAMZ American Spirit Connection, Inc.

TEAM AGREEMENT OF COMPLIANCE FORM SDPW JAMZ CAMP - SAN DIEGO, CA DATE SUBMITTED:

A. As the parent or legal guardian of the above-listed child, I freely acknowledge that I have voluntarily registered my child to participate in cheerleading activities of JAMZ AMERICAN SPIRIT CONNECTION, INC., a California corporation (hereinafter “JAMZ”), which include dance, gymnastics, stunting, jumping and tumbling components. I acknowledge that my child’s participation in the JAMZ cheerleading activities entails both known and unanticipated risks that could result in serious and permanent physical and emotional injuries to my child, my child’s death, damage to property, and injury to others. I understand that such risks are inherent in the activities and that even with precautions and safety measures they simply cannot be eliminated without jeopardizing the essential qualities of the activities. I also understand and acknowledge that injuries received by my child may be compounded or increased by negligent rescue operations or the assistance of JAMZ Representatives (defined below). Understanding such dangers, I hereby knowingly and voluntarily enroll my child in the JAMZ cheerleading event, I give my permission for my child to engage in the activities described herein, and I assume the risk of the activities involving my child. I understand that my child would not have permission to participate in the JAMZ cheerleading activities without agreeing to these terms and conditions. B. I represent that my child is in good health, that I adequately informed JAMZ Representatives running the activities of any special instructions regarding my child’s health or physical condition. I certify that I have adequate insurance to cover any injury or damage that my child may suffer while participating in the JAMZ cheerleading activities. I agree to bear the costs of any injury or damages my child may suffer while participating in the JAMZ cheerleading activities. I hereby authorize JAMZ Representatives to call for medical care for my child or to transport my child to a medical facility or hospital if in the opinion of such personnel, my child needs medical attention. I hereby authorize and grant permission to emergency medical personnel to administer first aid or immediate medical treatment to my child should my child become injured or ill. C. On behalf of my child and myself, I hereby knowingly and voluntarily release and forever discharge JAMZ or its employees, agents, coaches, instructors, assistants, officers, directors, owners, shareholders, subcontractors, and any other representatives or affiliates and their respective heirs, successors, and assigns (collectively with JAMZ, “JAMZ Representatives”) from any and all liability arising out of or in connection with the above-described activities involving my child. “Liability” means any and all claims, demands, losses, causes of action, lawsuits or judgments of any and every kind that occurs during or incidental to the above-described activities, that results from any cause whether caused by the negligence of the JAMZ Representatives or otherwise. D. I hereby agree to and shall indemnify, defend, save and hold harmless JAMZ Representatives from and against any and all loss, liability, damage, or cost JAMZ Representatives may incur, including attorneys’ fees and litigation costs, arising out of or related to the above-described activities, whether caused by the negligence of JAMZ Representatives or otherwise. E. I hereby agree that the assumption of risk, the release and waiver of liability, and the indemnity agreements contained herein extend to all acts of negligence by JAMZ Representatives including negligent rescue operations, is intended to be as broad and inclusive as is permitted by the laws of California and any other state whose laws apply to the activities described herein, and that if any portion of this form is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. F. I give JAMZ Representatives the right to photograph or video tape my child, or likeness of my child, for any reproductions associated or in any way connected with any televised or filmed event undertaken by JAMZ. Specifically, I hereby forever and irrevocably grant to JAMZ a license and permission to use any such photographic or video reproduction of my child in any form of advertisement for JAMZ or its promotional purposes. G. By signing this form I represent that I have read this form thoroughly and understand it completely, including the substantial legal rights I am giving up for my child and myself by signing it. I have had the opportunity to have my own attorney review this form and my attorney has done so or I have knowingly and voluntarily chosen not to have my attorney review this form. I have signed this form freely and voluntarily without inducement of any kind or guarantee being made by JAMZ Representatives or anyone else. I intend by my signature for this form to be a complete and unconditional release of any and all liability to the greatest extent allowed by law. I understand and agree that this form cannot be amended or modified by any oral statements or other writings from any JAMZ Representatives and that it is binding on my child, myself, and our heirs, successors, distributees, guardians, legal representatives, and assigns.

PARTICIPANT NAME Stephanie Smith

DOB F

M/F

Blue Cross

Insurance Company Name

MIKE Smith

Parent/Legal Guardian Signature

5/25/17

Date Signed

(555) 555-5555 Mike Smith

Cell # / Emergency Contact

/

01/01/95

This form is valid for any JAMZ event conducted from 05/31/2017 - 09/30/2017. This form MUST be filled out completely. Please photocopy this form and retain for your records. This form is not valid for JAMZ Championship Events. Fax this form to JAMZ Registration Department 209-578-1617 or Mail to JAMZ Summer Camps: PO Box 4308, Modesto, CA 95352.

EX.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 If you have more than 20 participants in your organization/team, please duplicate this form as necessary.

SDPW JAMZ CAMP - SAN DIEGO, CA

JUNIOR COACH/UNDERAGE COACH AGREEMENT OF COMPLIANCE FORM

Medical Treatment, Liability Release, & Appearance Agreement for JAMZ American Spirit Connection, Inc.

JAMZ REQUIRES EVERY COACH, JUNIOR COACH, TRAINER, ETC. UNDER THE AGE OF 18 PARTICIPATING AND/OR ATTENDING CAMP TO HAVE A PARENT/GUARDIAN SIGNATURE.

ORGANIZATION/TEAM NAME:

SIGNATURE:

MAIN CONTACT:

Have each coach, junior coach, trainer fill out their information in the spaces provided below with a parent/guardian signature. EACH coach under the age of 18 must have a parent/guardian signature in order to participate/attend camp.

DATE SUBMITTED:

A. As the parent or legal guardian of the above-listed child, I freely acknowledge that I have voluntarily registered my child to participate in cheerleading activities of JAMZ AMERICAN SPIRIT CONNECTION, INC., a California corporation (hereinafter “JAMZ”), which include dance, gymnastics, stunting, jumping and tumbling components. I acknowledge that my child’s participation in the JAMZ cheerleading activities entails both known and unanticipated risks that could result in serious and permanent physical and emotional injuries to my child, my child’s death, damage to property, and injury to others. I understand that such risks are inherent in the activities and that even with precautions and safety measures they simply cannot be eliminated without jeopardizing the essential qualities of the activities. I also understand and acknowledge that injuries received by my child may be compounded or increased by negligent rescue operations or the assistance of JAMZ Representatives (defined below). Understanding such dangers, I hereby knowingly and voluntarily enroll my child in the JAMZ cheerleading event, I give my permission for my child to engage in the activities described herein, and I assume the risk of the activities involving my child. I understand that my child would not have permission to participate in the JAMZ cheerleading activities without agreeing to these terms and conditions. B. I represent that my child is in good health, that I adequately informed JAMZ Representatives running the activities of any special instructions regarding my child’s health or physical condition. I certify that I have adequate insurance to cover any injury or damage that my child may suffer while participating in the JAMZ cheerleading activities. I agree to bear the costs of any injury or damages my child may suffer while participating in the JAMZ cheerleading activities. I hereby authorize JAMZ Representatives to call for medical care for my child or to transport my child to a medical facility or hospital if in the opinion of such personnel, my child needs medical attention. I hereby authorize and grant permission to emergency medical personnel to administer first aid or immediate medical treatment to my child should my child become injured or ill. C. On behalf of my child and myself, I hereby knowingly and voluntarily release and forever discharge JAMZ or its employees, agents, coaches, instructors, assistants, officers, directors, owners, shareholders, subcontractors, and any other representatives or affiliates and their respective heirs, successors, and assigns (collectively with JAMZ, “JAMZ Representatives”) from any and all liability arising out of or in connection with the above-described activities involving my child. “Liability” means any and all claims, demands, losses, causes of action, lawsuits or judgments of any and every kind that occurs during or incidental to the above-described activities, that results from any cause whether caused by the negligence of the JAMZ Representatives or otherwise. D. I hereby agree to and shall indemnify, defend, save and hold harmless JAMZ Representatives from and against any and all loss, liability, damage, or cost JAMZ Representatives may incur, including attorneys’ fees and litigation costs, arising out of or related to the above-described activities, whether caused by the negligence of JAMZ Representatives or otherwise. E. I hereby agree that the assumption of risk, the release and waiver of liability, and the indemnity agreements contained herein extend to all acts of negligence by JAMZ Representatives including negligent rescue operations, is intended to be as broad and inclusive as is permitted by the laws of California and any other state whose laws apply to the activities described herein, and that if any portion of this form is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. F. I give JAMZ Representatives the right to photograph or video tape my child, or likeness of my child, for any reproductions associated or in any way connected with any televised or filmed event undertaken by JAMZ. Specifically, I hereby forever and irrevocably grant to JAMZ a license and permission to use any such photographic or video reproduction of my child in any form of advertisement for JAMZ or its promotional purposes. G. By signing this form I represent that I have read this form thoroughly and understand it completely, including the substantial legal rights I am giving up for my child and myself by signing it. I have had the opportunity to have my own attorney review this form and my attorney has done so or I have knowingly and voluntarily chosen not to have my attorney review this form. I have signed this form freely and voluntarily without inducement of any kind or guarantee being made by JAMZ Representatives or anyone else. I intend by my signature for this form to be a complete and unconditional release of any and all liability to the greatest extent allowed by law. I understand and agree that this form cannot be amended or modified by any oral statements or other writings from any JAMZ Representatives and that it is binding on my child, myself, and our heirs, successors, distributees, guardians, legal representatives, and assigns. \

Stephanie Smith

JUNIOR COACH NAME

DOB

F

M/F

Blue Cross

Insurance Company Name

MIKE Smith

Parent/Legal Guardian Signature

5/25/17

Date Signed

(555) 555-5555 Mike Smith

Cell # / Emergency Contact

/ 01/01/95

This form is valid for any JAMZ event conducted from 05/31/2017 - 09/30/2017. This form MUST be filled out completely. Please photocopy this form and retain for your records. This form is not valid for JAMZ Championship Events. Fax this form to JAMZ Registration Department 209-578-1617 or Mail to JAMZ Summer Camps: PO Box 4308, Modesto, CA 95352.

EX.

1 2 3 4 5 6 If you have more than 6 underage coaches in your organization/team, please duplicate this form as necessary.

CREDIT CARD/E-CHECK AUTHORIZATION FORM 2017 SDPW JAMZ SUMMER CAMP

INSTRUCTIONS:

1) Choose which payment method you prefer and complete all info requested. 2) MAIL forms to: JAMZ SUMMER CAMPS: PO BOX 4308 MODESTO, CA 95352 or FAX forms to: (209) 578-1617. 3) Camp Registration and Payment are due to the JAMZ Office by: Monday, August 7, 2017

Team/Organization/School: ____________________________________________________________________ Camp Location: ABRAHAM LINCOLN HIGH SCHOOL, 4777 IMPERIAL AVE., SAN DIEGO, CA 92113 Camp Date: AUGUST 20, 2017 PLEASE PRINT LEGIBLY OR TYPE:

I, _______________________________________________ , here by authorize the following charges:

PRINT NAME

Total Number of JPW/PW/JM/M Participants: __________ X Fee Per Participant: $ Total Number of TM & MM Participants:

__________ X Fee Per Participant: $

PAYMENT OPTION 1 - CREDIT CARD INFORMATION

40.00 25.00

TOTAL AMOUNT TO BE CHARGED

= _________ = _________ $ __________

IF USING A CREDIT CARD, PLEASE CHECK ONE:



 VISA

 MASTER CARD

 AMERICAN EXPRESS  DISCOVER

Name as it appears on Credit Card: _______________________________________________________________ PRINT NAME Expiration Date: _____/_____ Credit Card Security Code: ____________ Billing ZIP Code: ______________ MONTH

YEAR

________________________________________ _____/_____/_____ ( SIGNATURE OF CARD HOLDER DATE Please write each digit of the Credit Card Number in the 16 blocks provided below:

) ___________________ CONTACT NUMBER

PAYMENT OPTION 2 - E-CHECK INFORMATION I AUTHORIZE JAMZ TO INITIATE EITHER AN ELECTRONIC DEBIT OR TO CREATE AND PROCESS A DEMAND DRAFT AGAINST MY BANK ACCOUNT ON OR AFTER THE DATE SUBMITTED FOR THE AMOUNT OF THE TOTAL CHARGE SHOWN ABOVE. I ACKNOWLEDGE THAT THE ORIGINATION OF ACH TRANSACTIONS TO MY ACCOUNT MUST COMPLY WITH THE PROVISIONING OF UNITED STATES LA LAW. AN NSF CHECK WILL RESULT IN AN AUTOMATIC DRAFT ON MY ACCOUNT FOR A $25 NSF FEE. MY ACCOUNT INFORMATION IS AS FOLLOWS: W. AN NSF CHECK WILL RESULT IN AN AUTOMATIC DRAFT ON MY ACCOUNT FOR A $25 NSF FEE. MY ACCOUNT INFORMATION IS AS FOLLOWS:

Name as it appears on Check: _______________________________________________________________ (TEAM, ORGANIZATION OR LEAGUE NAME ON CHECK) Routing Number:

Account Number:

________________________________________ SIGNATURE OF ACCOUNT HOLDER

_____/ _____/_____ DATE

(

) ___________________ CONTACT NUMBER

FOR OFFICE USE ONLY: DR ______________ DE ____________ IP _______________ CFM _______________