2026 Comet Skippers Summer Camp Registration

Participant Information

Partipant Name*

First NameLast Name

Current Team/School*

Team/School not listed

Coaches Name (if applicable)

Coaches Email (if applicable)

example@example.com

Grade for 2026-2027 school year

Birth Date*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Jumper Experience Level*

Basic (Little or no experience)ElementaryIntermediateAdvanced

T-Shirt Size (One shirt per registration - guaranteed only through May 22nd) Choose shirt size carefully, they are non-exchangeable*

Parent/Guardian Information

Name*

First NameLast Name

Cell Number*

Area CodePhone Number

Email*

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Allergies and/or Specific Health Considerations:*

Medications taken by participant on a daily or frequent basis:*

Options and Payment*

Camp Attendee$280.00

Camp registration includes a t-shirt if registered by May 22, 2026. Camp registration will change to $300 beginning May 23rd, and participants will no longer be guaranteed a t-shirt. No refunds after May 26th.

Add on a jump rope ($5-$12 depending on type)$5.00

Licorice ropes will be $5, Beaded ropes are $12.

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Medical release and Indemnity Agreement

I hereby request that you accept this application for registration in the Comet Skippers Summer Day Camp of my child named above, and in consideration of your acceptance of this application, I hereby release Comet Skippers Inc., Mason City Schools, and all of its facilities and employees and all persons associated with the Comet Skippers, Comet Skippers Summer Camp, of and from all claims or causes of injury to the participant arising from participation in the event, whether such injury is a result of negligence or some other cause. If medical attention is required for injury or illness while at the Comet Skippers Summer Day Camp, I give permission for such medical care and will be financially responsible. I also give permission for photography and or video to be taken and used in the future for possible promotion of the workshop.

*Comet Skippers Summer Camp is not a Mason City Schools activity.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Do you agree to the above?*

I Agree

Signature:*