B N Motion running camp

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Rain or shine!   

Drum Point Sports Complex, Brick Township, (Behind Emma Havens Middle School)

For kids ages 5-12 who want to improve their fitness, endurance, and speed while having fun!! All paces welcome!! 

$80.00 per child. $10.00 off per sibling. Cash or Check

Please bring a water bottle and wear comfortable clothes and athletic shoes

  dianne@bellanmotion.com

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Child’s name__________________ Age____ Sex___ Grade____

Parent’s Name (s) _______________________________

Address_____________________ City______ State_____

Zip______ Phone____________ Emergency Contact_______________

Email_______________

I ____________________________________________ (print name) understand that running, stretching and training include the risk of injury. I assume all risks including, but not limited to, falls, contact with other participants, the effects of weather, the condition of the surface and the traffic on the roads. I represent that I am medically able to participate in this program and, if requested, will provide a medical clearance from my doctor. I assume all these risks for myself, my heirs, executors and administrators. I hereby waive and release Bella N Motion and Dianne DeOliveira from any and all claims, liabilities and causes of action that I may have from my participation in this training program.

I/We GRANT permission_______ or I/We DO NOT GRANT permission_______ to use any photographs or videos of camp participants to be published on Bella N Motion’s websites, social media sites, and in flyers or publications for legitimate purposes. 

DATE: ______________    

SIGNATURE OF PARENT: ___________________________________________________