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Official Keystone Mascots Camp Registration Form

Who?
Three day training camps for high school, collegiate, corporate,
professional sports, and individual mascots.
What?
Learn the basics of character development, performance skills, costume care, and working with
advisors and other spirit groups. Each camper will take home skits they can use at games or
special promotional events, video recordings of themselves in
action and in practice, and our official Keystone Mascots
Training and Administrative Manual.
Where and When?
July 10, July 11, July 12 2020
Location: Lancaster, Pa.
Host: Millersville University
9:00 AM to 4:00 pm each day at the Student Memorial Center
Dance Studio. Hersheypark evening outing on Friday,
Lancaster Barnstormers Graduation Game on Sunday.

Keystone Mascots Training Staff who have experience in MLB, NHL, NFL, NCAA, Disney World,
Hersheypark, and other corporate and professional sports venues. For information on our
Trainers: http://keystonemascots.com/training/

Name: _________________________________________________________________________

Camper/Parent/Guardian Email Address_______________________________________________

Organization: ___________________________________ Phone: _________________________

Mailing Address: _________________________________________________________________

City: ____________________________________ State: ______ Zip: ______________________

Mascot Advisor: _________________________________ Phone: _________________________

Advisor’s Email Address: __________________________________________________________

If you paid through PayPal ____ Check or Money Order: _____


If mailing send Check/Money Orders to:
Keystone Mascots LLC, Box 553, Brownstown, Pa. 17508 (717) 799-0233

If you are above the age of 18 and plan to participate or advise during any Keystone Mascots
Summer Camp you must have volunteer child abuse clearance form copies delivered to
Keystone Mascots and Millersville University no later than JULY 20. The volunteer
clearances are free. You can find information at this link:
http://dhs.pa.gov/publications/findaform/childabusehistoryclearanceforms/index.htm
KEYSTONE MASCOTS LLC RELEASE AND WAIVER OF LIABILITY ASSUMPTION OF FULL
RESPONSIBILITY FOR ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE AND
INDEMNITY AGREEMENT

The participant and parent(s) or legal guardian(s) will instruct the minor participant that prior to
participating in any and all activities or use of any and all equipment or facilities, he/she should inspect
the facilities and equipment to be used with me, and if he/she or I believe that anything is unsafe, the
participant or I will immediately advise a Keystone Mascots LLC., staff member of the condition, and
refuse to participate.

I, as the minor participant and my parent, prior to participating in any and all activities, have inspected
the equipment and facilities to be used, and believe them to be safe, and am satisfied with the
condition of the facilities and equipment.
We fully understand and voluntarily accept that:
a. There are risks and dangers associated with participation in any and all activities, which could
result in, but are not limited to, bodily injury, partial and/or total disability and death.
b. I, as the minor participant, have no physical or mental condition which would interfere with my
ability to participate in or attend any such event or activity, or which would endanger my health or
safety.
c. I am warranting that my minor child has no mental or physical condition that would interfere with
his/her ability to participate in or attend any such event or activity, or that would endanger his/her
health or safety.
d. The social and economic losses and/or damages, which could result from those risks and
dangers described above from said participation in any and all activities, could be severe.
e. These risks and dangers may be caused by the actions, inaction, negligence or carelessness on
the part of Keystone Mascots LLC., or any of its officers, agents, servants, or employees. f.

There may be other dangers and risks from said participation in any and all activities not known
to us or not foreseeable at this time.

IN CONSIDERATION of permitting _________________________ to participate in any and all

activity with Keystone Mascots LLC, beginning on the ____ day of ____________, 201___, the
undersigned agrees for himself/herself, his/her family, his/her heirs, administrators and assigns, and
voluntarily releases, discharges and promises not to sue and not to hold liable Keystone Mascots LLC.
or any of its officers, agents, servants or employees for any and all claims for personal injury, property
damages or wrongful death occurring to himself/herself arising out of engaging (or receiving
instructions) in said activity or any activities incidental thereto whenever or however it may occur and
for whatever period the activities or instructions may continue and whether it is caused by the
negligence or carelessness, or otherwise, of the persons or entities conducting or sponsoring the event
or instruction.

The undersigned further agrees, for himself/herself, his/her family, his/her heirs, executors,
administrators, and assigns, that in the event any claims for personal injury, property damage or
wrongful death shall be prosecuted against Keystone Mascot LLC. or any of its officers, agents,
servants or employees, he/she shall indemnify, save and hold harmless the same Keystone Mascots
LLC. or any of its officers, agents, servants, or employees for any and all claims by whomever or
wherever made for personal injuries, property damage or wrongful death whether caused by the
negligence, carelessness, or otherwise, of the persons or entities mentioned above.
On behalf of the minor participant and individually, the Undersigned parent(s), or legal guardian(s) for
the minor participant executes this Release and Waiver. If, despite this release, the participant makes
a claim against the Keystone Mascots LLC. or any of its officers, agents, servants, or employees the
parent(s) or legal guardian(s) agree that he/she:
1. Will reimburse/indemnify Keystone Mascots LLC. or their insurance company for any money, which
they paid to the participant
2. Will reimburse/indemnify Keystone Mascots LLC. or their insurance company for any reasonable
costs incurred, including attorney’s fees.
3. Will hold Keystone Mascots LLC. harmless.

I, on behalf of the minor participant and individually, further agree and promise to hold harmless and
indemnify Keystone Mascots LLC.. or any of its officers, agents, servants, or employees from all
deferred costs, including attorney’s fees, or from any other costs incurred in connection with claims for
personal injury, property damage or wrongful death which I, or the minor participant, may negligently or
intentionally cause to a third parties in the course of participating in any and all activities.

If any portion of this agreement is held invalid, it is agreed that the balance thereof shall continue in full
leg force and effect.

It is the intention of _________________________ by this document to relieve Keystone Mascots


LLC. or any of its officers, agents, servants, or employees from any responsibility for personal injury,
property damage or wrongful death whether caused by the negligence, carelessness, or otherwise, of
the persons or entities mentioned above.

We take pictures of our camps throughout the year for our website. Please note that your child may be
photographed and may appear on our website. By signing this waiver you are giving consent for such
an occurrence.

I UNDERSTAND I AM ASSUMING ALL RISKS INHERENT WITH ANY AND ALL


ACTIVITIES THAT I AM PARTICIPATING IN, WHETHER KNOWN OR UNKNOWN,
AND THAT BY SIGNING THIS DOCUMENT I AM GIVING UP MY RIGHT TO SUE
KEYSTONE MASCOTS LLC. WHETHER CAUSED BY THE NEGLIGENCE OF THE
SAID PERSONS OR ENTITES.

I VOULUNTARILY SIGN MY NAME EVIDENCING MY ACCEPTANCE OF THE


ABOVE PROVISIONS, AND FURTHER AGREE THAT NO ORAL
REPRESNETATION, STATEMENTS OR INDUCEMENTS APART FROM THE
AGREEMENT HAVE BEEN MADE.

I HAVE READ THE DOCUMENT. I UNDERSTAND IT IS A RELEASE OF ALL


CLAIMS.

1. ______________________________________ ________________________________
Parent or Guardian (Signature/Relationship) Date

2. _______________________________________
Child (Signature if old enough) Date

3. _______________________________________
Witness (Signature) Date

KEYSTONE MASCOTS LLC + BOX 553 + BROWNSTOWN, PA. 17508


MEDICAL INFORMATION CARD

Participant’s Name: _____________________________ Explain any “YES” answers

Date: _________________
Have you had any illness or injury since your last physical?

Have you had any surgery?

Are you currently taking any prescription or non-prescription medications?

Do you have any allergies? (Food, Medications, Insect Stings, etc.)

Do you have asthma?

Do you have heart disease?

Do you have headaches?

Do you have seasonal allergies?

Do you wear glasses or contacts?

Do you have Diabetes?

Have you had previous fractured bones or dislocated joints?

Record the dates of your most recent immunizations

Tetanus____________ Hepatitis B____________ Measles____________ Chicken Pox____________

Signature Required I, ___________________________________the parent/guardian of __________________________,


give permission for emergency medical treatment of my child if I cannot first be contacted.

___________________________________________________________________________________.
Signature Required – Participant or Parent / Guardian

Please list and describe any other medical concern(s) that we should be aware of:

______________________________________________________________________________________

Warning of Risk to Participant & Insurance


Keystone Mascots LLC. is not responsible for providing medical accident injury insurance on students.
Parents must provide adequate accident and medical insurance for the student enrolled in training with
Keystone Mascots. Keystone Mascots LLC. shall not be held responsible for treatment or losses due
to participation in activities before, during or after classes or due to activity connected to the complex
hosting camp.
Please be advised that any activity involving motion or height creates the possibility of accidental
injury. Parents and participants should be aware that injury is possible in connection with this or any
athletic activity.
Parents assume all responsibility for any injury and all medical costs due to participation in any activity
at Keystone Mascots training camp and the host venue.
I have read the above policy and both understand and accept it.

___________________________________ ___________________
Signature Date

KEYSTONE MASCOTS LLC + BOX 553 + BROWNSTOWN, PA. 17508