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1. Athlete's name:______________________________ 2. Parent's Name(s):____________________________ 3. E-mail: ___________________________________ 4. Address:___________________________________ 5. City:_____________________________________ 6. State/Zip:_________________________________ 7. Home Phone:(_____)________________________ 8. School(08-09):_____________________________ 9. Grade: (08-09)____________________________ 10. Please Circle all that apply: Kiddie Camp - August 2-22 - 9:30-11:30am -$30 All Skills – July 8-11 All Skills – July 8-11 - 12:30-4pm - $50 All Skills – July 14-17 O & D Camp – July 14-17 - 12:30-4pm - $50 Coach's Signature (for O&D Campers only) __________________________________________________ 11. T-shirt size (Adult sizes--Please circle one) Kiddie Camp excluded YL S M L XL XXL 12.
Picture Release: ___________________________________________
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13. Permission to Treat Form I authorize camp and/or school personnel to transport my son/daughter to a physician's office and/or emergency room for treatment in the event that emergency medical care is needed while s/he is involved in the NEWLHS Volleyball camp. Further I authorize the PHYSICIAN and HOSPITAL STAFF to treat my son/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:_____________________ 15. Thank you for registering! Please send this page with fee to (please make checks payable to NEWLHS Volleyball Camp): NEW LHS VOLLEYBALL CAMP I look forward to seeing you at camp. God
bless!
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