Please Print this page and fill it out to sign up for the camps. Dallas Fencers Club Summer Camp. 14540 E Beltwood Parkway, Dallas TX 75244 214-629-5358 Nationally acclaimed fencing coach, Waldek Czaja, is offering camps for beginner fencers, ages 6 and up. Three camp dates to choose from: June 7th thru June 11th, July 19st thru July 23rd and August 9th thru 13th. Time: 9:30 AM until 2:00 PM Cost: $190 Class size is limited. Send registration and payment to: Dallas Fencers Club, 14540 E Beltwood Parkway, Dallas TX 75244 or call 214-629-5358 for information about on-site registration. Campers should wear shorts, t-shirt and athletic shoes. Bring a sack lunch and drink. Register us for June 7-June 11____ July 19-23____ August 9-13____ All Three____ Name:_____________________________________________________ Parents:__________________________________________________ Address:__________________________________________________ Home phone:_______________________________________________ Mobile phone:_____________________________________________ Medical Conditions or Restrictions: _________________________________________________________ Fencers age _________________________________________________________ Is the fencer right or left handed?: _________________________________________________________ Is the fencer male of female?: _________________________________________________________ I authorize the coach or manager in charge to consent to medical treatment when either I or my assignee cannot be contacted. I agree to hold harmless from any and all responsibility arising from any injuries or damages resulting from or in connection with the participation of the student in this camp and further agree to indemnify the coaches, instructors, appointed agents or appointed volunteers, by virtue of any of their acts or omissions related to such activities. Signature of Parent or Guardian:__________________________________________ Date:___________________