Camp Registration Form

YOUTH Boxing-Fitness Day Camp

SATURDAY, FEBRUARY 21, 2026. 9:00AM - 12:00PM. LOCATION: 6809 Hwy. 90, Ocean Springs, MS *across from St. Paul Church (inside Pruitt's Martial Arts) To reserve your place in the camp, you must complete the form below accurately.
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Current Age *
Home Phone Number*
Mobile Number*
Email Address*
example@example.com
Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide any medical or dietary restrictions you have*
Water and a healthy choice snack will be provided. WE WILL NOT provide a snack to students with allergies.
How did you hear about Camp?

Parent/ Guardian Information
Parent/Guardian's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number*
E-mail Address*
example@example.com

Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Relationship to Student*

Your Reason For Attending This Camp
In 300 words or less, please describe your reasons for wishing to attend this camp.

0/300
Release and Waiver of Liability

It is policy that any individual with a history of heart disease, back injury, or other potentially disabling injury or disease should consult a physician before engaging in any activity at Pruitt's Martial Arts & Fitness, its Youth Boxing-Fitness Camp, and/or by any coaches or instructors. The signed participant or parent/guardian represents that he/she is in good physical condition and able to use the equipment, facilities, and participate in all activities of the boxing training/classes/training camps and programs at Pruitt's Martial Arts.

Signed participant or parent/guardian fully understand and agree that when participating in activities at Pruitt’s Martial Arts & Fitness, its Youth Boxing-Fitness Camp, or the program offered therein, there is a possibility of accidental injury or other physical injury. Participant or parent/guardian understand and agree that they are using the facility and participating in all personal training, group training, boxing, conditioning, training, and/or Martial Arts activities, training classes and/or programs at their own risk. Participant or parent/guardian further agree to assume the risk of such injury to self or noted minor and further agree to indemnify and hold harmless; Coaches-Trainers, Pruitt’s Martial Arts & Fitness, its Youth Boxing-Fitness Camp, counselors, owner; Mr. Derek W. Pruitt, administrators, all instructors and staff.

In the event that the participant or parent/guardian is acquiring family participation and said participant’s family will be engaging in any activity at The Youth Boxing-Fitness Camp, Training camps, Pruitt’s Martial Arts & Fitness, the participant or parent/guardian signed below agrees to indemnify and hold harmless; Coaches, Trainers, The Youth Boxing-Fitness Camp as a whole, Training camp, Pruitt’s Martial Arts & Fitness, owner; Mr. Derek W. Pruitt, counselors, administration, all instructors and staff from any and all liability of injury or damage to the said family member(s) as a result of the participant or family member’s negligence, the actions of participant, participant’s family or third parties at The Youth Boxing-Fitness Camp, it's Training Camp or Pruitt’s Martial Arts & Fitness. In the event the participant or parent/guardian or his/her family bring a guest to the facility, the participant and guest both agree to indemnify and hold harmless; Coaches, Trainers, Counselors, Training Camp, and Pruitt’s Martial Arts & Fitness, owner; Mr. Derek W. Pruitt, administration, all instructors and staff from any and all liability of injury and/or damage to said guest as a result of the guest’s, signed participant or parent/guardian’s , participant's family or third party’s negligence, the actions of the guest or noted participant, participant’s family or third parties at The Youth Boxing-Fitness Camp, its Training Camp, or Pruitt’s Martial Arts & Fitness.

If participants engage in light sparring during the Youth Boxing-Fitness Camp, he/she are participating at their own risk and agree to hold harmless and without fault Mr. Derek W Pruitt, Pruitt's Martial Arts, its coaches, staff, or instructors from any liability from injury that may occur during sparring. Parents agree to allow students to participate in the light sparring at their own risk and own free will and assume all risk and liability for any injury that may occur during the light sparring training.

The Youth Boxing-Fitness Camp, Mr. Derek W. Pruitt, it's coaches, trainers, and staff ARE NOT RESPONSIBLE FOR ANY INJURY DURING TRAINING AND ARE NOT RESPONSIBLE FOR ANY INJURIES DURING LIGHT SPARRING.

I agree and understand by my signature below. MUST be 18yrs or older to sign.
Signature*

Clear
Release and Waiver of Liability

It is policy that any individual with a history of heart disease, back injury, or other potentially disabling injury or disease should consult a physician before engaging in any activity at Pruitt's Martial Arts & Fitness, its Youth Boxing-Fitness Camp, and/or by any coaches or instructors. The signed participant or parent/guardian represents that he/she is in good physical condition and able to use the equipment, facilities, and participate in all activities of the boxing training/classes/training camps and programs at Pruitt's Martial Arts.

Signed participant or parent/guardian fully understand and agree that when participating in activities at Pruitt’s Martial Arts & Fitness, its Youth Boxing-Fitness Camp, or the program offered therein, there is a possibility of accidental injury or other physical injury. Participant or parent/guardian understand and agree that they are using the facility and participating in all personal training, group training, boxing, conditioning, training, and/or Martial Arts activities, training classes and/or programs at their own risk. Participant or parent/guardian further agree to assume the risk of such injury to self or noted minor and further agree to indemnify and hold harmless; Coaches-Trainers, Pruitt’s Martial Arts & Fitness, its Youth Boxing-Fitness Camp, counselors, owner; Mr. Derek W. Pruitt, administrators, all instructors and staff.

In the event that the participant or parent/guardian is acquiring family participation and said participant’s family will be engaging in any activity at The Youth Boxing-Fitness Camp, Training camps, Pruitt’s Martial Arts & Fitness, the participant or parent/guardian signed below agrees to indemnify and hold harmless; Coaches, Trainers, The Youth Boxing-Fitness Camp as a whole, Training camp, Pruitt’s Martial Arts & Fitness, owner; Mr. Derek W. Pruitt, counselors, administration, all instructors and staff from any and all liability of injury or damage to the said family member(s) as a result of the participant or family member’s negligence, the actions of participant, participant’s family or third parties at The Youth Boxing-Fitness Camp, it's Training Camp or Pruitt’s Martial Arts & Fitness. In the event the participant or parent/guardian or his/her family bring a guest to the facility, the participant and guest both agree to indemnify and hold harmless; Coaches, Trainers, Counselors, Training Camp, and Pruitt’s Martial Arts & Fitness, owner; Mr. Derek W. Pruitt, administration, all instructors and staff from any and all liability of injury and/or damage to said guest as a result of the guest’s, signed participant or parent/guardian’s , participant's family or third party’s negligence, the actions of the guest or noted participant, participant’s family or third parties at The Youth Boxing-Fitness Camp, its Training Camp, or Pruitt’s Martial Arts & Fitness.

If participants engage in light sparring during the Youth Boxing-Fitness Camp, he/she are participating at their own risk and agree to hold harmless and without fault Mr. Derek W Pruitt, Pruitt's Martial Arts, its coaches, staff, or instructors from any liability from injury that may occur during sparring. Parents agree to allow students to participate in the light sparring at their own risk and own free will and assume all risk and liability for any injury that may occur during the light sparring training.

The Youth Boxing-Fitness Camp, Mr. Derek W. Pruitt, it's coaches, trainers, and staff ARE NOT RESPONSIBLE FOR ANY INJURY DURING TRAINING AND ARE NOT RESPONSIBLE FOR ANY INJURIES DURING LIGHT SPARRING.

I agree and understand by my signature below. MUST be 18yrs or older to sign.
Phone Number*
Please enter a valid phone number.
Signature*

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CONDUCT CODE / BEHAVIOR POLICY / WORKOUT CLOTHES/SHOES

ALL participants MUST maintain a resspectful behavior during the entire Camp day/time. There will be NO FOUL LANGUAGE, CURSING, BULLYING, DISRESPECTFUL BEHAVIOR TO ANY COACH/STUDENT/OR HELPER OF THE CAMP.

ALL participants MUST be respectful and use all equipment provided with care and respect. ANY DAMAGE, CAUSE OF DAMAGE, DESTRUCTION, OR STEALING/THEFT will NOT be tolerated and offenders will be held accountable and prosecurated to the fullest extent of the law.

ALL guests, parents, and family members MUST maintain a respectful behavior during the camp day/time, and NO FOUL LANGUAGE, CURSING, BULLYING, DISRESPECTFUL BEHAVIOR, OR IRRATIC BEHAVIOR will be tolerated and WILL RESUULT IN YOUR STUDENT BEING EXPELLED FROM THE CAMP AND NO REFUND GIVEN FOR FEES PAID.

*WORKOUT CLOTHING/SHOES*

ALL participants MUST wear shirts, shorts, or workout style clothing during the camp sessions. NO apparel with OFFENSIVE MATERIAL, LANGUAGE, ETC...will be allwoed during the Day Camp Session.

SHOES - MUST be worn during the entire DAY CAMP session and MUST be worn to and from the building.

FAILURE TO FOLLOW THESE GUIDELINES/POLICIES OF THE 2026 YOUTH BOXING-FITNESS DAY CAMP WILL RESULT IN THAT PERSON/PERSONS BEING ASKED TO LEAVE THE CAMP AND PROPERTY IMMEDIATELY AND THERE WILL BE *NO REFUND* OF ANY/ALL FEES FOR THE DAY CAMP.

WE ASK THAT ALL PARTICIPANTS, GUESTS, PARENTS, AND FAMILY MEMBERS SET THE EXAMPLE OF BEHAVIOR.
Signature*

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AUTHORIZED PICK PERSON (Valid ID may be requested by camp director)*

First NameLast Name
AUTHORIZED PICK PERSON (Valid ID may be requested by camp director)*

First NameLast Name
AUTHORIZED PICK PERSON (Valid ID may be requested by camp director)*

First NameLast Name

My Products

CAMP DAY #1-JUNE 9-13YOUTH BOXING-FITNESS DAY CAMP. 9AM-12PM. FEBRUARY 21, 2025. $40-Camp Fee + $5-processing fee.

$45.00

Total

$0.00

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YOUTH Boxing-Fitness Day Camp

Parent/ Guardian Information

Emergency Contact Information

Your Reason For Attending This Camp

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