Registration: 2019 Summer Youth Camp

First Name *

Last Name *

Birth Date * +

Gender *

T-Shirt size *

Experience Level *

Intermediate Fencer Please Indicate Weapon

How did you find out about this camp? *

Registration Interest

July 8 - July 12: Youth Day Camp (I) * 🛈

Full Day

1/2 Day Morning (9:00am - 12:00pm)

1/2 Day Afternoon (1:00pm - 4:00pm)

I'm not interested in this session

July 15 - July 19: Youth Day Camp (II) * 🛈

Full Day

1/2 Day Morning (9:00am - 12:00pm)

1/2 Day Afternoon (1:00pm - 4:00pm)

I'm not interested in this session

August 19 - August 23: Youth Day Camp (III) * 🛈

Full Day

1/2 Day Morning (9:00am - 12:00pm)

1/2 Day Afternoon (1:00pm - 4:00pm)

I'm not interested in this session

Contact Information

Address 1 *

City *

State *

Zip *

Address 2

Phone *

Email Address *

Allergies or Food Restrictions *

Emergency Contact *

Emergency Phone *

Medical Insurance (Carrier and Policy #) *

Waiver and Consents

Waiver of Liability and Consent to Treatment

I hereby agree to waive all liability of Marx Fencing Academy, Marx Fencing LLC, and (Michael Marx or Lisa Bell) and its staff, for any accident, injury, illness or other mishap which might befall the above-named camper. Furthermore, I hereby grant permission to the staff and any medical or surgical consultant deemed advisable and any hospital to render to the above-named camper any medical and surgical treatment that they deem necessary. I understand that all possible efforts will be made to contact me before any such treatment.

Marx Fencing LLC also reserves the right to send a camper home if need arises.

Yes, I have read and agreed to these terms. *

SIGNATURE

Photo Release Form

I hereby grant Marx Fencing permission to interview me and/or to use my likeness in photograph(s) /video in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by Marx Fencing, in perpetuity, and for other use by Marx Fencing LLC. I will make no monetary or other claim against Marx Fencing LLC for the use of the interview and/or the photograph(s)/video. *

SIGNATURE for Yes, I've read and agreed to these terms.

SIGNATURE for No, I do not give my permission.

Newsletter Subscription

Stay connected to stories and events happening at Marx Fencing Academy through the monthly newsletter, Marx Monthly, which will be sent on the first Monday of every month. Don't worry, if you don't like it after receiving a couple of issues, there's a simple "unsubscribe" button at the bottom of the newsletter. *

Ok, sign me up.

No, please don't sign me up.

Payment

*

July 8 - July 12: Full Day ($550)

July 8 - July 12: 1/2 Day ($325)

July 15 - July 19: Full Day ($550)

July 15 - July 19: 1/2 Day ($325)

August 19 - August 23: Full Day ($550)

August 19 - August 23: Half Day ($325)

Camp Payment

Extended Day Afternoon Only

This camp must comply with the regulations of the MA Department of Public Health and be licensed by the Concord Board of Health.