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Youth Spring Break Camp Registration Form

  1. Youth Spring Break Camps Registration Form

  2. Select all that you registering for:

  3. Child's Gender

  4. List name(s) and relationship to child

  5. *ART, GOLF, & SCIENCE camps only - Select camper's shirt size:

  6. Disclaimer

    The City of Choctaw also disclaims any and all responsibilities for accidents or injuries occurring during the activity. In consideration of my child's and/ or my participation , I, the signer, assume full and complete responsibility for my child's and my actions while participating in the activity or use of a facility owned by the City of Choctaw. I hereby indemnify and hold harmless the City of Choctaw and/ or its Director, Manager, Coordinators, Employees, Volunteers, Agents, Servants, Officers, Elected Officials, and Independent Contractors from any and all claims, actions, demands, costs, liabilities, expenses, or judgement, whatsoever which might arise in any manner from my use of the facilities on City of Choctaw property. I understand there is inherent risk in participating in any physical activity. This release and waiver extends to all claims of every kind of nature, whatsoever, foreseen and unforeseen, known or unknown.

  7. By entering my name here I am agreeing to the above listed terms and conditions.

  8. Leave This Blank:

  9. This field is not part of the form submission.