Registration - 2024 Polar Bear Rugby Camp

1		2		3		4		5		6
Registration Details		Parent/Guardian Information (if camper is under 18)		Rugby Information		Emergency Contact		Waiver		Payment

Parent/Guardian Information (if camper is under 18)
Parent/Guardian Name
N/A

Required First Required Last
Relationship to Camper *
N/A
Parent/Guardian Email *
N/A
Parent/Guardian Cell Phone *
N/A
N/A

I certify that I am authorized to register on behalf of the camper listed in this application. * I certify that I am authorized to register on behalf of the camper listed in this application. Required

Emergency Contact Information
Emergency Contact
N/A

Required First Required Last
Relationship to Camper *
N/A
Emergency Contact Email *
N/A
Emergency Contact Phone *
N/A

Camp Agreement (to be completed by a parent/guardian if camper is under 18)
Polar Bear Rugby Camp LLC is owned and operated by Head Coach MaryBeth Mathews, is held at Bowdoin College, and uses some of the College's facilities. However, Polar Bear Rugby Camp is not owned or operated by the College, and the Head Coach and Coach's assistants are not employees or agents of the College in their operating of the camp.

Please read the following agreement carefully before signing. Although camp participation is encouraged, it is encouraged only if health and safety are considered. Students under 18 years of age must have parent or legal guardian sign and date below.
Certification of Physical Fitness to Participate *
N/A
I understand that a risk of participating in any sport, including Polar Bear Rugby Camp, is the risk of injury, including but not limited to serious permanent injury, paralysis, and death. To minimize the risk of injury, I agree to obey/tell my child to obey all safety rules and to report/tell my child to report fully any problems related to my/his or her physical condition to the summer camp coaches or assistants as soon as the problem begins.

By signing below, I certify the following:
That I am not, or my child is not, currently under the care of a physician for an injury or illness that would prevent his/her safe participation in the summer camp;
That I am not, or my child is not, currently being treated for or recovering from an orthopedic injury that would prevent his or her safe participation in the summer camp;
That I have, or my child has, no history of fainting or other problems related to strenuous exercise; and
That I am, or my child is, in good health and there is no reason he or she cannot safely participate in strenuous physical activity.
By checking this box, I am indicating my understanding and agreement.
Consent *
N/A

By my consent below, I hereby give permission for Polar Bear Rugby Camp and its employees and agents to obtain medical treatment for me or my child in the event of accident or illness during their presence at the camp.

By my consent below, I hereby give consent to have me or my child be photographed or video- or audio-taped during camp activities, and I agree that the images so obtained may be used for educational and public relations purposes by Polar Bear Rugby Camp.

By checking this box, I am indicating my understanding and agreement.
Release *
N/A

In consideration for accepting me or my child into Polar Bear Rugby Camp, which uses College facilities, I do hereby agree that I am and shall be responsible for all costs associated with any injury or loss that may be sustained by me or my child as a result of my, his, or her participation at the camp. I also certify that I have health insurance that provides adequate coverage for injuries or illness that I or my child may sustain while participating in Polar Bear Rugby Camp.

By my release below, I also agree to release and promise not to sue the State of Maine, Bowdoin College, or their employees or agents, for any damages, loss, injury, or death arising from my or my child's participation in Polar Bear Rugby Camp, unless such damages, loss, injury, or death are caused by willful and wanton conduct of such employees or agents.

By checking this box, I am indicating my understanding and agreement.
Name of Person Completing Waiver
N/A

Required First Required Last
Relationship to Camper *
N/A

If camper is over 18 and signing their own waiver, please put "self."

Payment

Please enter your information to pay by credit card, Venmo or select the pay by check box and wait for an email with further instructions. Your amount is automatically calculated if you pay by credit card.
Registration is not complete until payment is received. If you choose to pay by check, be sure to postmark your check by the stated registration deadlines in order to receive the appropriate rate.

Early Registration (by April 22) - $600 residential/$475 commuter
Registration (After April 22) - $650 residential/$525 commuter
Registration Fee
N/A
Pay by Credit Card

Stripe USD

$
N/A

Pay by Venmo: @PolarBearRugbyCamp Pay by Venmo: @PolarBearRugbyCamp

Payments are due immediately following registration and must be received by the specific deadlines in order to get the stated rate.
N/A

Pay by Check Pay by Check

Instructions to pay by check will be included in your confirmation email if you have checked this box. Payments are due immediately following registration, and must be received by the specific deadlines in order to get the stated rate.
Rate at Time of Registering
N/A
Approved Reg Fee
N/A

List total amount for each camper, even if full price
Approved Payment Plan Details (if not full price)
N/A

i.e. 3 payments of $100 made on 5/1, 6/1, 7/1
Invoiced?
N/A
Payment Amount #1
N/A

For full price, paid in full registrants, just enter the full amount as payment #1
Payment #1 Date
N/A

MM/dd/yyyy
Payment #1 Stripe Deposit Amount
N/A
Payment #1 Stripe Deposit Date
N/A

MM/dd/yyyy
Payment Amount #2
N/A
Payment #2 Date
N/A

MM/dd/yyyy
Payment #2 Stripe Deposit Amount
N/A
Payment #2 Stripe Deposit Date
N/A

MM/dd/yyyy
Payment Amount #3
N/A
Payment #3 Date
N/A

MM/dd/yyyy
Payment #3 Stripe Deposit Amount
N/A
Payment #3 Stripe Deposit Date
N/A

MM/dd/yyyy
Med Form and Insurance Card Submitted Date
N/A

MM/dd/yyyy
Cancelation Status
N/A
Comments
N/A

Error Occurred

You haven't verified your email yet, click here to receive a verification email.

Registration - 2024 Polar Bear Rugby Camp

Camper Information

Parent/Guardian Information (if camper is under 18)

Rugby Information

Emergency Contact Information

Camp Agreement (to be completed by a parent/guardian if camper is under 18)

Payment

Error Occurred

Link to resume this form later:

Turn on the camera permission in your browser to continue further