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2023 *** New*** Summer Camp Registration Form
PLAYER INFORMATION
*
First Name:
*
Last Name:
*
Street:
*
City:
*
State:
*
Zip Code:
*
Home Phone:
*
Birthdate:
Jan
Feb
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Apr
May
Jun
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2011
*
Email:
Gender:
M
F
*
Grade:
K
1
2
3
4
5
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7
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9
10
11
12
PARENT/GUARDIAN #1
*
Firstname:
*
Lastname:
*
EMail:
Home Phone:
Work Phone:
*
Cell Phone:
PARENT/GUARDIAN #2
Firstname:
Lastname:
Email:
Home Phone:
Work Phone:
Cell Phone:
MEDICAL/EMERGENCY CONTACT INFORMATION
Emergency Contact:
Phone:
Relationship to Player:
Insurance Carrier:
Policy #:
WAIVER INFORMATION
*** Insert your waiver information here ***
I/we agree with the above
*
* indicates required fields