Wild Axe Lumberjack Camp

Wild Axe Lumberjack Camp
Cost of Camp: $172.50/child ($150 + HST )
Please make cheque payable to Wild Axe Productions - can pay by cheque, cash or e-transfer to xlsports@mac.com

Choose Camp *

Camp 1 - August 2-6 Ages 10-13 Camp 2 - August 9-13 Ages 13-16

* Indicates required field

Parent/Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Emergency Contact Number *

Email *

Participant Name *

First

Last

Date of Birth *

Age *

Does participant have any medical conditions, allegies, or special needs the staff should know about? *

Yes No

If yes, please explain *

Does the participant have any behavioral or emotional issues the staff should be aware of? *

Yes No

If yes, please explain. *

Is the participant taking any medications to treat these conditions? *

Yes No

If yes, please provide instructions for leaders. *

EMERGENCY AUTHORIZATION

I, the undersigned, parent or guardian of the above-named individual, acknowledge that participation in athletic events necessarily involves risk of physical injury. In consideration for accepting the registration of the above named individual and permitting the voluntary participation of said individual in its programs, I (for myself as well as for my child, his/her heirs and assigns) hereby release, discharge and hold harmless Wild Axe Productions and its employees, volunteers and other representatives or affiliates (including without limitation the facilities and volunteers) from and against any and all claims arising out of or relating to illness, physical injury, death or other damages that may result to said individual while participating in the Lumberjack Kids Camp. I attest that my child is physically capable to participate in this event. However, should staff/volunteers determine in their sole discretion that completion or participation in any events would be injurious to my child’s health or should my child become ill or injured, I consent to his or her removal and treatment by any physician or medical care provider at the direction of the volunteers and/or staff. I give my permission for free use of my child’s name and picture in broadcasts, telecasts or written accounts of any game and or events that is sponsored by Wild Axe Productions.

Name *

First

Last

Date *

Submit

WILD AXE LUMBERJACK CAMP

Wild Axe Lumberjack Camp
Cost of Camp: $172.50/child ($150 + HST )
Please make cheque payable to Wild Axe Productions - can pay by cheque, cash or e-transfer to xlsports@mac.com

HALIFAX

TIMBER LOUNGE Halifax
Halifax, Nova Scotia

TEMPORARILY CLOSED

WILD AXE LUMBERJACK CAMP

Wild Axe Lumberjack CampCost of Camp: $172.50/child ($150 + HST )Please make cheque payable to Wild Axe Productions - can pay by cheque, cash or e-transfer to xlsports@mac.com

HALIFAX

TIMBER LOUNGE HalifaxHalifax, Nova ScotiaTEMPORARILY CLOSED

Wild Axe Lumberjack Camp
Cost of Camp: $172.50/child ($150 + HST )
Please make cheque payable to Wild Axe Productions - can pay by cheque, cash or e-transfer to xlsports@mac.com

TIMBER LOUNGE Halifax
Halifax, Nova Scotia

TEMPORARILY CLOSED