Amount remitted $_____________    Balance Due _________________

PLEASE MAKE CHECKS PAYABLE TO: Debbie Matthews

26001 Corriente Ln. Mission Viejo, CA 92691

Gate fees extra.  Must sign a release form and pay fees prior to start of school. Rider and crew participates at own risk.  Rider has the option at anytime to withdraw from school for any reason.  Rider acknowledges the WSMX is not obligated to provide refunds.  Rider agrees to hold harmless school, agents, instructor or track and personnel and covenants not to sue.  Rider agrees to abide all rules and follow instructions given.

Rider Signature __________________________________ Date ____________

Parent/Guardian Signature _______________________ Date ____________

Drivers License Number of Consenting Parent or Guardian______________

Notary Signature (required if parent of child under 18 not present) 

Signature: ____________________________________ Date ___________ SEAL

Amount remitted $_____________ Balance Due $_____________ Skill Level/Experience ___________

PLEASE MAKE CHECKS PAYABLE TO: Debbie Matthews

26001 Corriente Ln. Mission Viejo, CA 92691

Gate fees extra.  Must sign a release form and pay fees prior to start of school. Rider and crew participates at own risk.  Rider has the option at anytime to withdraw from school for any reason.  Rider acknowledges the WSMX is not obligated to provide refunds.  Rider agrees to hold harmless school, agents, instructor or track and personnel and covenants not to sue.  Rider agrees to abide all rules and follow instructions given.

Rider Signature __________________________________ Date ____________

Parent/Guardian Signature _______________________ Date ____________

Drivers License Number of Consenting Parent or Guardian______________

Notary Signature (required if parent of child under 18 not present) 

Signature: ____________________________________ Date ___________ SEAL

Name ___________________________________________________________________   Address __________________________________________________________________
City _________________________________    State ____________    Zip _____________
Phone # _______________________________   Gender _______ Age of student _______
Email ______________________________________   Skill Level/Experience __________
In Case of Emergency notify: __________________________ Phone_________________
School Date requested: ____________________ Location: _________________________   _____ I wish to attend Both Days-Class Fee-$400.00            Minimum Deposit $200.00 _____ I wish to attend One Day Only-Class Fee-$200.00      Minimum Deposit $100.00 **Payment Plan Available-Please contact us for Details _____ I am eligible for the Family Member or Returning Student Discount of $50.00 per day off the balance of the school fee.   Last School Attended __________________________   _____ I am eligible for the special offer of $100.00 off the balance of the school fee because ___________________ will be attending the school with me as a NEW full paying Student.  I understand he/she must pre-register and attend the school or I will lose the discount. *Discount offers may not be combined.  You may utilize one or the other upon qualification
Rental Equipment (If Needed) Extra $75.00 a day fee applies:    Please list sizes and equipment needed below:
Pant___ Jersey___ Gloves___ Helmet___ Gloves ___ Goggles___(Std or OTG)
Bike Rental If Needed:  Please enter Rider:  Height _____  Weight _____ Payment Options for the camp:  _______ I have enclosed the total payment for the camp  _______ I have enclosed a 50 % deposit for the camp _______ Other Arrangements (Pre-Approved By WSMX) With this deposit of $ _________ , please reserve a space for me at the camp.  I promise to pay the balance due before start of camp or my deposit and reservation is forfeited.  No exceptions Note: If I am unable to attend the camp, and with the determination of each individual case made by the WSMX, CEO, I understand that up to $ 300.00 of my registration may be returned.  I also understand that WSMX will retain $100.00 of the total amount required for the camp to cover cancellation costs, and will not be returned.   Payment  (please circle one)    Cash       Check       Money Order     Pay Pal   Amount remitted __________     Signature of Applicant______________________________________   To Be completed by WSMX Staff:   Amount Paid $_______ Balance Due $_______ Discount Applied  $ ______ Initials ____  Date Recv_____
Gate fees extra.  Must sign a release form and pay fees prior to start of school. Rider and crew participate at own risk.  Rider has the option at anytime to withdraw from school for any reason.  Rider acknowledges the WSMX is not obligated to provide refunds.  Rider agrees to hold harmless school, agents, instructor or track and personnel and covenants not to sue.  Rider agrees to abide all rules and follow instructions given.
Rider Signature ___________________________________ Date ______________
Parent/Guardian Signature __________________________ Date _____________
Drivers License Number of Consenting Parent or Guardian _________________
Notary Signature (required if student under 18 w/o parent attending) Notary Signature_____________________________________________________ Date _____________________ Seal
PLEASE REMIT TO:
Debbie Matthews
26001 Corriente Ln.
Mission Viejo, CA 92691