Pole Vault Summer Camp 2022

Registration Form

This is our first ever Pole Vault Summer Camp! This camp is open to rising 6th through 12th graders and adults who are interested in Pole Vault and/or those who want to improve their skills. Technical instruction will be done by Coach Andrew Corman, CCA's very successful Track and Field coach.

18 Sessions, Monday, Wednesday and Friday 3PM-5:30PM

Sessions start Monday, June 27th and end Friday August 5th.

Register for the

Entire summer for $500

Large block session June 27-July 22 or July 11- August 5 for $350

Any 2 weeks for $175

or

Each session for $30

Participant Information

First Name *

Last Name *

Sex *

Birth Date * 🛈 +

Grade This Fall *

Entire Summer Option

June 27-August 5th

Large Block Option. Please Choose one.

Large Block Session June 27-July 22

Large Block Session July 11- August 6

Biweekly Option. Please choose two.

Single Session Option. Please choose your sessions

Session 1: 6-27-2022

Session 2: 6-29-2022

Session 3: 7-1-2022

Session 4: 7-6-2022

Session 5: 7-8-2022

Session 6: 7-11-2022

Session 7: 7-13-2022

Session 8: 7-15-2022

Session 9: 7-18-2022

Session 10: 7-20-2022

Session 11: 7-22-2022

Session 12: 7-25-2022

Session 13: 7-27-2022

Session 14: 7-29-2022

Session 15: 8-1-2022

Session 16: 8-3-2022

Session 17: 8-5-2022

Current Total:

$0.00

Parent / Legal Guardian Information

Relationship to Participant(s): *

First Name *

Last Name *

Address *

City *

State *

Zip *

Phone *

2nd Phone *

Email Address *

Health Insurance Information

Participant First Name *

List any physical or emotional limitations your child/participant may have: *

By checking this box, I confirm that the participant(s) is/are covered by Health Insurance. Participant(s) must have Health Insurance to participate in this camp. Please provide Health Insurance information below. *

I confirm that the participant(s) is/are covered by Health Insurance.

Health Insurance Carrier *

Policy Holder's Full Name *

Health Insurance ID Number *

Health Insurance Phone Number *

Waiver Information

READ THIS WAIVER, RELEASE, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT FOR RISKS, INCLUDING BUT NOT LIMITED TO, COMMUNICABLE DISEASES (COVID-19)

By clicking on this form, you confirm that you have read and agree to all terms in the above Waiver, Release, Assumption of Risk and Indemnification Agreement for Risks, Including But Not Limited To, Communicable Diseases (COVID-19). *

I have read and agree to all terms in the Waiver, Release, Assumption of Risk and Indemnification Agreement for Risks, Including But Not Limited To, Communicable Diseases (COVID-19).

An email confirmation and payment receipt will be sent to the email address listed.

If you do not receive both of these emails, you have not successfully registered for the camp. Be sure to check your spam folder.

Please contact camp support at accounting@canyoncrestfoundation.org if you need assistance.