Transcript Slide 1

2015 Pirate Conditioning Course
Check the athletics website http://classroom.ptisd.org/webs/athletics/home.htm for registration options or complete this form
and deliver in person to the PTISD athletics office on the PTHS campus or by US mail to: PTISD Athletics, P.O. Box 5878
Longview, TX 75608.
If registering on the day of the camp please have completed form and proper payment available upon arrival.
Student Name: ____________________________________Grade 15 - 16: ________Campus: ______________________
Parent Name: __________________________________ Day Phone: ______________________
Please circle
Parent Name: __________________________________Day Phone: _______________________
T-shirt size*:
Phone:_________________________Email: ___________________________________________
**Please Note if Short
Address: ______________________________________________ Zip: _____________________
Size is Different**
Emergency Contact Name: __________________________Phone: ________________________
Child:
Medium
Large
Adult:
Small Medium Large
X-Large XX-Large
Camp Name
Date(s)
Make checks payable to: PTISD
Time: AM, PM
or Full Day
Athletics
Campus
Fee
Total
Parent Statements of Agreement & Guidelines
Please initial indicating you have read, understand, and agree to the guidelines below:
______I understand that I may not leave my student at the camp unless there is a staff member present.
______I understand that my student will not be allowed to leave the camp with an unauthorized person or staff
member. Only adults with valid photo ID, over the age of 18 can be authorized to pick up the student.
______I understand that I will be charged a $1.00 per minute late fee if I fail to pick up my student on time.
______I understand that my student may be removed from camp for any of the following reasons:
1. Failure to pay fees by designated deadlines.
2. Inappropriate behavior of a student that endangers themselves or others.
3. Failure to observe any of the conditions listed in the PTISD Student Code of Conduct.
______I release the Pine Tree Independent School District, its employees and agents from all claims and
responsibility for physical injury and property loss.
______I understand that a full refund, less a $10 processing fee, will be issued when I cancel in writing five (5)
business days before the camp begins. Fees will not be prorated for late enrollment, missed classes,
or non-attendance.
______I give my consent for PTISD staff to photograph my student with the understanding that my student’s image
could be used by PTISD for promotional materials, including the District’s web site, and may be shared with
the local news media.
Parent Signature: ______________________________________________
Date: ________________________
Non-Discrimination Statement:
The Pine Tree Independent School District operates all educational programs without discrimination on the basis of race, color, religion, sex, national origin, age,
disability or any other basis prohibited by law. The District complies with Title VII of the Civil Rights Act of 1964, Title IX of the Educational Amendments of 1972,
Americans with Disabilities Act, and Section 504 of the Rehabilitation Act of 1973.