2026 CAMP REGISTRATION

CAMP DATES:

Weeks 1,2- June 15-26th

*OFF June 29- July 2nd

Weeks 3,4,5- July 6-23rd

*OFF July 27-30th

Weeks 6,7,8- Aug 3-20th

**Please note if you are registering MORE than 1 athlete you will need to complete separate registration forms for each athlete**

PLAYER

PARENT/GAURDIAN

MEDICAL WAIVER

ACKNOWLEDGEMENT OF RISK AND AGREEMENT (required)

I consent to my child's participation in this training program. I understand that being involved in athletics presents some risks, including the possibility of damage to my child's property or serious injury to my child. I agree, on behalf of myself and my child, to assume all the risks, in connection with, my child's participation in the training program. I agree that my child will follow the relevant The Breakaway Program’s directions, rules, and policies and will obey instructions. I acknowledge that The Breakaway Program has the right to remove my child from participation in the Camp if they are not complying with the rules and regulations of the Camp.

HEALTH AND SAFETY (required)

I know of no health-related reasons or problems, which preclude or restrict my child from participating in the Camp.

MEDICAL RELEASE (required)

I grant medical personnel permission to provide medical care for conditions, which may arise during participation in this training program. The Breakaway Program does not assume any responsibility nor provide any insurance for medical expenses incurred by your dependents as a result of any accident or sickness while they are participating in this Camp.

RELEASE OF LIABILITY (required)

I agree to release Shea Klitzke, The Breakaway Program (Commit Fitness LLC), and its trustees, officers, employees, volunteers, members, and representatives from any and all liabilities and claims whatsoever arising out of, or in connection with, my child's attendance and participation in the training program, even those that may have been caused by the ordinary negligence of Shea Klitzke and The Breakaway Program.

ACKNOWLEDGEMENT (required)

By reading and signing this legally binding document, I know I am voluntarily waiving the right to sue Shea Klitzke and/ or The Breakaway Program (Commit Fitness LLC) if my child is injured while participating in this Program. In the event of my incapacity or death, this agreement binds my heirs, executors, administrators, and representatives.

MEDIA ACKNOWLEDGEMENT (required)

The Breakaway Program may make and use images, film, video, and audio recordings of my child, and take and use quotes or statements from my child, during the activity, without compensation. I release all claims against The Breakaway Program with respect to privacy, copyright ownership, and publication, related to the use of the quotes, images, or recordings.