REGISTRATION FORM

Name________________________________Date of Camp(s)_________________

Age__________ Weight________ _Approx. pole size________________________

Address________________________________ Tel#________________________

_______________________________________E-mail______________________

Waiver

Whereas the undersigned athlete ("Member") wishes to join and use the facilities of Just Vault ("Vault") and Whereas the owner of 

Vault, Todd Cooper ("Cooper") wishes to limit any liability he may have now or in the future for any injury to Member or his guests,

however caused, including, without limitation, Cooper's negligence, IT IS AGREED: That in consideration of this agreement and 

Cooper allowing Member to join Vault and use its facilities, the Member expressly agrees that Cooper shall not be liable for any 

damages arising from personal injuries sustained by the Member or his guests in, on, or about the premises of Vault or as a result

of their using the facilities and the equipment therein. By the execution of this agreement Member assumes full responsibility for

any such injuries or damages which may occur to the member or his agents and servants, and does hereby fully, and forever, 

release and discharge Cooper, his agents and servants, from any and all claims, demands, damages, rights of action or causes of

action, present or future, whether the same be known or unknown, anticipated or unanticipated, resulting from or arising out of the

Member's or his guests use or untended use of the facilities of Vault or the equipment therein. 

Athlete(Member)___________________________________________  Date__________________

Parents__________________________________________________________________________

(print and mail with $45.00 deposit) to:  Todd Cooper  15801 Park Lane  Excelsior Springs, MO 64024              

Or: pay online by clicking on the purchase link.