Camp Registration – Captain Pump

HOME
SEL LEADERSHIP PROGRAM
CAPTAIN’S CORNER
JOIN SEL ONLINE PROGRAMS
My account
- MY Dashboard
- Parent Corner
MEMBER LOGIN

Camp Registration

Camp Registration

Thank you for your interest in the Captain Pump Hero Leadership Camp. Please complete the form below to reserve your son’s place in the Pumpster Hero Challenge.

Enrollment is limited to 25 boys ages 9–12.

Captain Pump Hero Leadership Camp

Parent / Guardian Information

Parent / Guardian Full Name *

Email Address *

Phone Number *

Emergency Contact Name *

Emergency Contact Phone Number *

Child Information

Child's Full Name *

Preferred Name / Nickname *

Date of Birth *

Month

Day

Year

Age *

Grade Level *

T-Shirt Size *

Health and Participation Information

Does your child have any allergies? *

Does your child have any medical conditions we should know about? *

Is your child currently taking any medications? *

Does your child have any injuries or physical limitations? *

Physician Name *

Physician Phone Number *

Parent Insight (Optional but Helpful)

Why would you like your son to participate in the Captain Pump Hero Leadership Camp? *

What are one or two things you hope your son gains from this experience? *

Program Confirmation

You are registering your child for:

⚡ Captain Pump Hero Leadership Camp

Program Dates

May 26 – July 30

Sessions

Tuesdays & Thursdays
9:00 AM – 12:00 PM

Additional Training

First four Mondays
9:00 AM – 12:00 PM

Total Sessions

24 Hero Leadership Sessions

🎓 Pumpster Graduation Ceremony
Saturday, August 1st at 10:00 AM

Enrollment Fee

Select your membership plan *Early Hero Enrollment - $997Full Program Enrollment - $1,295

A 3% processing surcharge will be added at checkout.
Payment must be made in full to reserve your son's place.
Enrollment is limited to 25 boys.

Agreement and Consent

Please review and confirm the following: *I understand that participation in the Captain Pump Hero Leadership Camp includes physical activities, games, and exercise.

I confirm that my child is physically able to participate in the program.

I understand that enrollment is limited and my child's place is reserved only after payment is completed.

I understand there are no refunds after the camp program begins.

I agree to the Waiver, Release, and Participation Agreement

RELEASE AND WAIVER:

Participation in the Captain Pump Hero Leadership Camp includes physical exercise, games, teamwork activities, and movement-based training.

I understand that participation in physical activity involves inherent risks, including but not limited to strains, sprains, falls, collisions, or other injuries. By registering my child, I acknowledge and voluntarily assume all such risks, whether known or unknown.

I certify that my child is physically able to participate in camp activities and has no medical condition that would prevent safe participation. I agree to inform camp staff of any relevant medical conditions, allergies, or limitations prior to participation.

In the event of a medical emergency, I authorize Captain Pump staff to obtain necessary medical care for my child if I cannot be reached immediately. I understand that I am responsible for any medical expenses incurred.

I agree to release, waive, and hold harmless Captain Pump Hero Leadership Camp, Jasson Finney, TJF Enterprises LLC, and all staff, contractors, and affiliates from any and all claims, liabilities, damages, or causes of action arising out of or related to my child’s participation in the program.

I further agree to indemnify and hold harmless all parties listed above from any claims brought by or on behalf of my child or any third party.

I understand that participation is voluntary and that my child is expected to follow all rules and behavioral standards. I acknowledge that inappropriate or disruptive behavior may result in immediate dismissal from the camp without refund.

I grant permission for Captain Pump Hero Leadership Camp to use photographs and/or video recordings of my child for promotional and marketing purposes, unless I provide written notice opting out.

This agreement shall be governed by and interpreted in accordance with the laws of the State of Arizona.

By registering, I confirm that I have read, understood, and agree to the terms above.

Parent Name *

Date *

Month

Day

Year

Signature *

Media Permission (Optional)

Select *Yes, I allow my child to appear in photos or videos used for Captain Pump promotional purposes.No, I do not allow my child to appear in promotional photos or videos.

What would you most like your child to gain from this program?

Examples: *ConfidenceLeadership skillsFitness habitsSocial skillsDisciplineOther:

Let's talk about the characters in the book,

The Adventures of Captain Pump - The World's First Fitness Superhero

Copyright © 2022, Made with ♥ by UNICORN ANIMATION