Jump Camp Application
Print the forms below and send in with your camp deposit.
Make cashier's check or money order for non-refundable deposit
(see above section for deposit amount) or payment in full
payable to Airtime Jump Camps and mail to:
c/o Rick Attig
10104 Sunset Dr.
Lenexa, KS 66220
MEDICAL HISTORY (to be completed by the parent)
Is there a known history of:
A. Birth deformities? Yes_____No_____
B. Medical conditions currently under treatment
C. Pre-existing injury currently under treatment? Yes_____No_____
D. Fractures or other disability type injuries? Yes_____No_____
E. Allergy? Yes_____No_____
F. Mental disorder or convulsions? Yes_____No_____
G. Known past illness of more than one week’s duration? Yes_____No_____
H. Contact lenses or glasses? Yes_____No_____
EXPLAIN ABOVE QUESTIONS ANSWERED “YES”
guardian’s signature) hereby agree to save, ademnify and keep
harmless, the Blue Valley School District and Rick Attig’s Camps
from all liability, claims, judgements, or demands for damage
incurred while above camper is attending one of Rick Attig’s
Airtime Jump Camps. Please fill out the application completely
and mail it along with a non-refundable deposit. If the camp is
full the deposit will be refunded.
I hereby state that Airtime Jump Camp is not responsible for
any pre-existing injury or reoccurrence of any undisclosed
pre-existing injury or illness of the above camper prior to
the first day the camper registers. I authorize Rick Attig to obtain medical assistance for my child if needed and release my child to attention as required and deemed necessary by a physician.
Signature of Parent or Guardian
PHYSICIAN’S STATEMENT (or a copy of school physical
I hereby certify that I have examined _________________________
and found him/her physically fit to attend and participate in
the jump camp, and I know of no impairments which would
limit his/her participation in all activities in the camp.
Date of last tetus immunization_____________
High Jump Camp
Airtime Jump Camps