NEWLHS Softball Camp

Registration Form

Name:__________________________

Parent's Name:___________________

E-mail: _________________________

Address:________________________

City:___________________________

State/Zip:_______________________

Home Phone:(_____)______________

School/City:_____________________

Grade: (07-08--Please Circle)   

6th     7th     8th     9th

Age:___________________________

T-shirt size (Adult sizes--Please circle)

S      M      L      XL

Please fill out the permission to treat form to the right and send this page with $35 (please make checks payable to NEWLHS Softball Camp) to:

GIRLS SOFTBALL CAMP

N.E.W. Lutheran High School

1311 S. Robinson Ave.

Green Bay, WI  54311

Questions?  Please Call:

Kellie Meerstein  (H) 406-8738

I look forward to seeing you!

Permission to Treat Form

I authorize camp and/or school personnel to transport my daughter to a physician's office and/or emergency room for treatment in the event that emergency medical care is needed while she is involved in the 2007 NEWLHS Softball camp.  Further I authorize the PHYSICIAN and HOSPITAL STAFF to treat my daughter, as they deem necessary in the emergency situation.

Parent/Guardian Signature:

__________________________________

Date: _____________________________

Insurance Carrier:

__________________________________

Policy #:___________________________

Known Allergies:_________________________

Medical Conditions and/or Medications

_______________________________________

Father's Full Name: ________________________

Father's emergency phone:__________________

Mother's Full Name:_______________________

Mother's emergency phone:_________________

Family Doctor's phone:_____________________

Family Dentist's phone:_____________________