Registration Form
First Name
Last Name
Address
City
State
Home Phone
Email
Parent's Name
Cell Phone
Grade
Age
The participant assumes all risks associated with participation in the program; the Panthers assume
no liability for injury or damages arising from participation in the program. Due to the strenuous
nature of some activities, the Panthers encourage each participant to consult his or her physician
concerning fitness to participate in the program. The participant consents to emergency treatment.
The participant also consents to the Panther’s use if any photographs taken or video tapes made of
the program. If the participant is a minor, the parent or guardian approves his or her participation in
the program.
