Nellya Fencers
Atlanta Georgia USA
NELLYA FENCING CAMP 2012
Sessions
Choose Sessions:
*
Session 1: June 4-8
Session 2: June 11-15
Session 3: June 18-22
Session 4: June 25-29
Session 5: July 9-13
Session 6: July 16-20
Session 7: July 23-27
Session 8: July 30 - August 3
Cost
Camper
Fencer's Name
*
Fir
st Na
me
Ni
ckna
me
La
st Na
me
Gender
Boy
Girl
Birth Date
January
February
March
April
May
June
July
August
September
October
November
December
Month
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
Day
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
Year
Cell Phone
-
Area Code
Phone Number
Sibling
Second Fencer
Fir
st Na
me
Ni
ckna
me
La
st Na
me
Gender
Boy
Girl
Birth Date
January
February
March
April
May
June
July
August
September
October
November
December
Month
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
Day
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
Year
Cell Phone
-
Area Code
Phone Number
Sibling
Third Fencer
Fir
st Na
me
Ni
ckna
me
La
st Na
me
Gender
Boy
Girl
Birth Date
January
February
March
April
May
June
July
August
September
October
November
December
Month
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
Day
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
Year
Cell Phone
-
Area Code
Phone Number
Static
Family
Parent or Guardian
*
Mother
Father
Grandmother
Grandfather
Guardian
Other
Relation
Fir
st Na
me
La
st Na
me
Home
*
-
Area Code
Phone Number
Work
-
Area Code
Phone Number
Cell
-
Area Code
Phone Number
E-mail
*
Address
Street Address
Street Address Line 2
City
State / Province
Zip Code
United States
Other
Country
Waiver
I hereby waive and release all rights and claims for damages I may have against Nellya Fencers, Inc., the United States Fencing Association, the officials, managers, sponsors and other participants from any and all liabilities arising from illness, losses, injuries or damages I may suffer as a result of my participation in the Nellya Fencers Summer Fun Fencing Program. I understand that participation in the sport of fencing carries a risk to me of serious injury. I attest and verify that I am physically fit and prepared for strenuous physical activity. I further waive all rights to any photographs, videotapes, or any other recording of this event for any purpose
*
I have read and understood this waiver.
Consent for Medical Treatment:
I understand that participation in the sport of fencing carries a risk to me of serious injury. I give my consent to representatives of Nellya Fencers, Inc. to obtain medical care from physicians, clinics or hospitals for any illness and/or injury that could arise during Nellya Fencers Summer Fun Fencing Program.
*
I give this consent.
Emergency Contact:
*
Phone Number
-
Area Code
Phone Number
Continue to Payment
Promotional Code
Groupon
Living Social
I have an Auction Certificate
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