Moss Farms Diving: Register for the Summer Diving Camp

Personal Information

Name*

FirstLast

Phone*

Sex*

Female
Male

US Diving #*

If you do no yet have a US Diving Number, visit US Diving to become a member.

Birthdate*

Diver's Address*

Street AddressCityState / Province / RegionZip / Postal CodeCountry

Parent or Guardian Information

Name*

FirstLast

Address (if different from Diver's)

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Phone*

Email*

Diving Coach

Name*

FirstLast

Team*

Address*

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Phone*

Email*

Diving Session

Choose which sessions you'd like to be in*

Summer Diving Camp

T-Shirt Size*

Adult Sizes

Application and Fees

Fees are $575 per session with a non-refundable deposit of $150 due 30 days prior to arrival. Balance is due upon arrival. Failure to pay all fees in advance will result in forfeiture of all deposits and exclusion from the diving facility.

Required Documents

All the below documents must be submitted with this application

Letter from Diving Coach*

Reccomendation and permission to attend.

Medical Insurance Card*

Or some other proof of medical insurance showing the name of the insuring company and policy number.

Letter from Physician*

Statement of physical condition from physician (M.D.) certifying your physical ability to participate in diving camp activities. Please have your physician list any drug allergies or other unusual conditions affecting your physical condition or your ability to receive medical treatment.

Conditions

Applicable to all Prospective Campers. Check all to show you understand.*

Moss Farms Diving, Inc. reserves the right to accept or reject any and all applications.
Your diving coach must approve your application to attend this camp.
You do not and will not engage in the illegal possession and/or use of drugs or alcohol while residing in the Colquitt County, Georgia area during dive camp.
You will engage in exemplary, responsible conduct while attending diving camp and while residing in the Colquitt County are. You understand that Moss Farms Diving, Inc. assumes no responsibility for your conduct.
You will follow all instructions given to you by Representatives from Moss Farms Diving, Inc. when you are at diving camp and during your stay when we provide lodging.
Moss Farms Diving, Inc. reserves the right to immediately dismiss you from diving camp, exclude you from the diving facilities, notify your parents and/or coach, or take other action deemed appropriate by Moss Farms Diving, Inc. should you violate any of the above provisions at the divers expense.

Waiver of Liability

In consideration of acceptance of Moss Farms Diving, Inc. of your application, you hereby agree and understand that diving is a dangerous sport and that the possibility exists that you could become seriously injured while at diving camp. You hereby agree to assume all risk of injury, hereby releasing Moss Farms Diving, Inc., their coaches, employees, agents, and/or representatives from any and all claims of damages for injury which occur or may occur while attending diving camp at the Moose Moss Aquatic Center in Moultrie, Georgia, or while otherwise under the supervision of any such coach, employee, agent or representative of Moss Farms Diving, Inc. and further agree to indemnify and hold harmless Moss Farms Diving, Inc. and its coaches, employees, agents and/or representatives from any and all claims for damages suffered by reason of injury to you while attending diving camp.*

I understand and accept.

Medical Treatment

You hereby give permission to Moss Farms Diving, Inc. to give consent to any and all medical treatment, including admission to the hospital, advised by a physician (M.D.) should you suffer injury while attending diving camp. You further agree to be solely responsible for the expenses of any and all such medical treatment.*

I understand and accept.

Signature

Clicking these checkboxes signifies a digital signature and acceptance of the above terms and conditions.

I HAVE READ THE ENTIRE CONTENTS OF THIS APPLICATION AND UNCONDITIONALLY AGREE TO SAME.*

I understand and accept.

Applicants Name*

FirstLast

Date*

Parent or Guardian's name*

FirstLast

Date*

Dive

with champions

REGISTER NOW

Please Note:

Application for Diving Camp

Personal Information

Parent or Guardian Information

Diving Coach

Diving Session

Application and Fees

Required Documents

Conditions

Waiver of Liability

Medical Treatment

Signature

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