Youth Camp | PRG Scholarships

1. Participant (Child) Information

Full Name *

Date of Birth *

Age / Grade

Gender

2. Parent / Guardian Information

Parent/Guardian Name *

Relationship to Child

Primary Phone *

Email Address *

Home Address

3. Emergency Contact & Medical Information

Emergency Contact *

Phone *

Relationship

Medical Conditions / Allergies

Current Medications

Special Instructions / Accommodations

4. T-Shirt Selection

Please select one PRG Next T-shirt size for the participant: *

5. Mandatory Media & Video Recording Consent

PLEASE NOTE: The PRG Next Youth Fitness Camp at Blaze Sports and Fitness will be recorded on video and photographed in its entirety. This footage and photos will be published online on Phillip Reed Group platforms as educational resources and marketing content.

By registering your child for the PRG Next Youth Fitness Camp, you understand and acknowledge that media recording is an essential and mandatory element of the program. Because the event is captured live as a group, Phillip Reed Group cannot filter, exclude, or remove individual participants from video footage or group photography.

I grant Phillip Reed Group, its representatives, and successors the irrevocable right and permission to record, photograph, stream, publish, and distribute video recordings and photos containing my child's image, voice, and likeness across online platforms (including websites, educational resource libraries, YouTube, and social media channels) and promotional materials without limitation or compensation.

I have read and agree to the Mandatory Media & Video Recording Consent. *

6. Liability Waiver, Release & Medical Authorization

1. Assumption of Risk: I, the undersigned parent or legal guardian, acknowledge that participation in the PRG Next Youth Fitness Camp run by Phillip Reed Group at Blaze Sports and Fitness involves physical activity, conditioning exercises, and sports drills. I understand that physical exercise involves inherent risks of injury. I voluntarily assume all risks associated with my child's participation.

2. Waiver and Release of Liability: In consideration for allowing my child to participate in PRG Next, I hereby release, waive, discharge, and hold harmless Phillip Reed Group, Blaze Sports and Fitness, and their respective officers, directors, employees, volunteers, agents, and facility hosts from any and all claims, liabilities, demands, or causes of action arising out of negligence or participation in camp activities.

3. Emergency Medical Authorization: In the event of an emergency or sudden injury, I authorize Phillip Reed Group staff and volunteers to secure necessary medical treatment, including first aid, CPR, emergency transportation, and hospital care, if I or my designated emergency contact cannot be reached immediately.

I have read and agree to the Liability Waiver, Release & Medical Authorization. *

7. Acknowledgment and Signature

By signing below, I certify that I am the parent or legal guardian of the participant, and that I have read, understood, and agree to all terms, mandatory media consent requirements, schedule/location details, and liability releases outlined in this document.

Parent / Legal Guardian Signature (type your full name) *

Parent / Legal Guardian Printed Name *

Date *