Winter Road Show Registration How did you Learn about the camp?*Previous MI camperPrevious 'Big Show' camperEmailWeb searchMy coach me about itCoach NameCamper Registration*Full payment ($349)Down payment ($100)Total $0.00 Camper Name* First Last Gender*MaleFemaleCamper Birthdate MM DD YYYY T-shirt Size*Youth LargeAdult SmallAdult MediumAdult LargeAdult XLSchool Grade*Please enter the number of the grade camper currently is in.Club/SchoolPlease list your club and/or school affiliationCamper city and state* City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Best Number to reach you during the day*Email* Email will be our main method of communication with you about camp, so please use an email you check frequently.Waiver and Release of Liability* I agree ties and / or use of such equipment may result in injury or illness including but not limited to bodily injury, disease, strains, fractures, partial and/or total paralysis, death or other ailments that could cause serious disability; (c) these risks and dangers may be caused by the negligence of Clark Keeper Training or Camp Shutout, the negligence of the participants, or the negligence of others. I hereby assume all risks and dangers and all responsibility for any losses and / or damages whether caused in whole or in part by the negligence or other conduct of anyone associated with Clark Keeper Training or Camp Shutout or by any other person. I, on behalf of myself, my personal representatives and my heirs hereby voluntarily agree to release, waive, discharge, hold harmless, defend and indemnify Clark Keeper Training, and Stan Anderson and Camp Shutout from any and all claims, actions or losses for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out of my participation in the goalkeeper training program. I also agree to allow Clark Keeper Training to use photographs and/or video of me to promote the West Michigan Camp Shutout program. BY CHECKING THE BOX ABOVE, I SIGNIFY THAT I HAVE READ THIS WAIVER AND RELEASE AND BY CHECKING THE BOX I AGREE. IT IS MY INTENTION TO EXEMPT AND RELIEVE CLARK KEEPER TRAINING FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.