FORM DETAILS

Form ID

Designation: 009302 - Stunt Prospect Camp*

ContactId:

EventId:

Camp Status

OPENCLOSED

Camp roster is FULL! We not accepting registrations at this time.

For questions or inquires, please contact Ariana Johnson at arjohnson@westmont.edu.

Take your skills to the next level and get noticed by the Westmont coaching staff! The Westmont STUNT Recruit & Skills Clinic is designed for high school and transfer athletes looking to sharpen their technical execution while experiencing a collegiate training environment.

Led by Head Coach Ariana Johnson, our heart for this clinic is to truly dive deep into the fundamentals. We will break down technique, learn new skill progressions, and focus on the safety and precision it takes to become a stronger, more impactful STUNT athlete. Whether you are aiming to fine-tune your mechanics or showcase your talents for future recruitment, this event offers the perfect platform to grow your game.

We can't wait to have you participate and get a glimpse of what it takes to be a

Westmont STUNT Warrior!

For questions or inquires, please contact Ariana Johnson at arjohnson@westmont.edu.

ATHLETE INFORMATION

First Name

Last Name

Address

City

State

Postal Code

Mobile Phone

Home Phone

PARENT INFORMATION

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Mobile

Add Secondary Parent/Guardian Information

SECONDARY PARENT/GUARDIAN

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Parent Mobile

ACADEMIC INFORMATION

Current School Name

Grad Year

YYYY

GPA

ACT

SAT

COLLEGE INFORMATION

Student Type

Will you enter college as a First Year or as a Transfer?

Term

When do you plan to begin your college education?

ROSTER INFORMATION

Primary Position

Secondary Position

Do you have prior tumbling experience?

YesNo

Shirt Size

Height

Weight

Club Team

PAYMENT DETAILS

Credit Card Type

Amount Due

Name on Card

Card Number

CVV Code

Billing Address

Billing City

Billing State

Billing Zip

LIABILITY WAIVER

Consent for Event Activities and for Treatment

PARTICIPANT

First Name

Last Name

Birth Date

EVENT INFORMATION

Event Name

MEDICAL INFORMATION

Mark as "none" where not applicable.

Known Allergies

Current Medications

Physical Restrictions

Previous Injuries

Other info that emergency assistance providers should know:

PARENT/LEGAL GUARDIAN

If Participant a minor; preferred contact otherwise.

First Name

Last Name

Mobile Phone

Home Phone

Work Phone

Address

City

State

Zip

MEDICAL PROFESSIONAL

Full Name

Office Phone

Mobile Phone

Pager

AUTHORIZED ADULT CONTACT I

Full Name

Mobile Phone

Home Phone

Work Phone

AUTHORIZED ADULT CONTACT II

Full Name

Mobile Phone

Home Phone

Work Phone

Authorization for Medical Care
If an injury or illness requires, in the opinion of the person in charge, urgent medical or dental examination or treatment, I authorize and direct that person (or their agent) to:
a) arrange transportation by car or ambulance to the closest hospital;
b) call the Medical Professional/s named above; and
c) attempt to reach one or more of the other listed contacts.
If a named Medical Professional is unavailable, I authorize any emergency treatment deemed necessary by a medical professional licensed for the required service.

Acceptance of Circumstances & Assumption of Risk
I understand that Westmont College assumes no financial responsibility or legal liability for medical care or ambulance transportation. I also verify that the Participant is in sufficient health to be able to participate in the event identified above. I recognize that all physical activity has some risk of injury.

Image Release
I authorize the use, in future program publications, of biographical, image, video or audio content recorded for or during event activities and include this Participant.

Acceptance of Circumstances & Assumption of Risk
I understand that Westmont College assumes no financial responsibility or legal liability for medical care or ambulance transportation. I also verify that the Participant is in sufficient health to be able to participate in the event identified above. I recognize that all physical activity has some risk of injury.

Image Release
I authorize the use, in future program publications, of biographical, image, video or audio content recorded for or during event activities and include this Participant.

Electronic Signatures
A signed copy of this waiver submitted via this form shall be deemed to have the same legal effect as delivery of an original executed copy of this waiver for all purposes.

SIGNATURE

Parent/Legal Guardian or Participant if over 18

Date

Continue to the next page to confirm and finalize this registration.