Summer 2017 Camp Registration *
Player Name *
Player Name
Gender
Date of Birth *
Date of Birth
Address *
Address
Cell Phone *
Cell Phone
To apply for $20 discount, list 4 other players here you are signing up with
Mother's Name *
Mother's Name
Father's Name *
Father's Name
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
$149 per player $129 per player for group of 5 or more
$
Payment
Expiration Date
Expiration Date
Name on Credit Card *
Name on Credit Card
As it appears on credit card
AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY
Signature *
Checking this box certifies that I, as parent or guardian with legal responsibility for the Participant, do consent and agree to the releases provided above.
Today's Date *
Today's Date