• CMEK Program Contract

Player Full Name(s)
Parents Name
Names and Grades
of your other children
Home Phone
Cell Phone
Street Address
Town
Zip
Email
School
Birthdate
Grade
Emergency Contact Name/Number
Names of People child can be discharged to
List physical/mental conditions or known allergies
(We do not administer any medication)
Name of Program Registering For:
Dates of Program Registering For:
Promotions/Discounts/Coupons:
Payment: Amount
Payment Type: Cash / Check / Credit Card via Paypal only (PayPal - 3% surcharge)
I agree that I am taking a spot in a CMEK program. In the event of an injury, I understand that all refunds will be in the form of credit to a future CMEK camp program. I agree that you may utilize photographs, testimonials, email addresses, and information relating to my child's participation in CMEK activities on your web site and other CMEK publicity and literature.

I hereby authorize the agents of CMEK ALLSTARS INC., to act for me according to his/her best judgment in any emergency requiring medical attention. I hereby release, discharge and indemnify CMEK ALLSTARS INC., staff, affiliated entities and their officers, agents and employees from and against any and all claims, liability, causes of actions, lawsuits or awards arising out of or in connection with my or my child's participation in the program. I agree that program locations and times are subject to change based on availability, inclement weather, and enrollment. I have read the CMEK code of conduct with my child and promise to abide by it.

I authorize this form to be used and updated accordingly for all CMEK programs that my child participates in for this current year

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