Brown’s Calming Grounds - Kids Agility Camp - Riverstone Montessori

PRE-REGISTRATION Required for Brown’s Calming Grounds - Kids Agility Camp - Location: Riverstone Montessori - Iowa Colony Location .

Text 832-264-0122. WWW.DBDLEAGUES.COM
Parent Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Parent Email*
example@example.com
Child Care Program Attending*
Please type the name of the childcare facility above.
Participants Name*

First NameLast Name
Additional Participant’s Name (Please only use if you are registering multiple participants)

First NameLast Name
Additional Participant’s Name (Please only use if you are registering multiple participants )

First NameLast Name
Early Childhood - 6th Grade*

Age 2.5 - 4yrsAge 5 - 6yrsAge 7 - 8yrsAge 9yrsAge 10yrsAge 11 - 12yrs
WAIVER, RELEASE, PHOTO USE RELEASE FORM and INDEMNITY AGREEMENT - I, the undersigned, being the parent, volunteer or participant involved in the Dr. Motivate LLC. youth sports or summer program project (the “Project”), or being the legal guardian of such a participant in the Project, in consideration of my or another’s participation in the Project, release, defend, indemnify and hold harmless Dr. Motivate LLC., its directors, officers, employees, contractors, volunteers, agents, representatives, invitees, and affiliates (“Dr. Motivate group”) from and against all liability, claims, losses, damages, punitive damages, costs, expenses, attorney's fees, demands, suits and causes of action of every kind and character arising in favor of myself, my child or participant in the Project or anyone claiming thereunder for personal injury, or death, or property damage in anyway incident to or arising out of participation in activities associated with the Project regardless of and expressly including the sole, joint, or concurrent negligence, gross negligence, statutory fault, or negligence per se of any party, including the members of the Dr. Motivate group. I (authorized person signing), hereby grant and authorize Dr. Motivate group the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of me or the program participant(s) and/or for legally promotional materials including, but not limited to, newsletters, fundraising letters, flyers, posters, brochures, submissions to journalists, websites, social networking sites, annual reports, press kits and other print and digital communications, without payment or any other considerations. This authorization extends to all languages, media, formats and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. If revoked no pictures from the day of notice moving forward will be used. Pictures taken prior to notice will not be subject for removal. I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.*

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Participant(s) Photo. Photos submitted or taken during the event could be used to welcome participants and or to promote events through Dr. Motivate LLC. By submitting an image, the parent/guardian gives the program and its affiliates permission to use the photo on social media platforms and promotional advertisements without financial obligation now and into the future.

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My Products

Agility Camp T-Shirt

$25.00

Size	Quantity	Price
YXS		$25.00
YS		$25.00
YM		$25.00
YL		$25.00
YXL		$25.00
AS		$25.00
AL		$25.00
AM		$25.00
AXL		$25.00
A2XL		$26.00
A3XL		$27.00

1st Time Drop-In RateFirst time drop-in rate. Drop-in rate can be used once. The camp fee is non-refundable.

$5.00 Quantity

Fall Sept Session 2025 1 - June 2025Regular rate - 4 Sessions - $15 each The camp fee is non-refundable.

$60.00 Quantity

Fall October 2025 Session 2Regular rate - 4 Sessions - $15 each The camp fee is non-refundable.

$60.00 Quantity

Fall November 2025 Session 3 Regular rate - 4 Sessions - $15 each The camp fee is non-refundable.

$60.00 Quantity

Bundle Package September, October and NovemberDiscounted bundle rate. The camp fee is non-refundable.

$150.00 Quantity

Total

$0.00

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PRE-REGISTRATION Required for Brown’s Calming Grounds - Kids Agility Camp - Location: Riverstone Montessori - Iowa Colony Location .

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