Camper's Name (First, Last)
Parent(s) Name(s)
Address
City
Zip Code
Home Phone #
Parent Work Phone #
Parent Cell Phone #
Male
Female
Age
Grade Entering
K
1
2
3
4
5
6
School Attending
Church Attending
List one person, who is attending Sports Camp, you would like to be a team with.
T-shirt Size
Youth S (4-6)
Youth M (8-10)
Youth L (12-14)
Adult S (34-36)
Adult M (38-40)
Adult L (42-44)
Adult XL (46)
Emergency Contact (other than parents)
Contact Home Phone #
Contact Cell Phone #
Medical Insurance Carrier
Policy #
Doctors Name
Parent/Guardian for Medical Treatment:
By inputting my name below, I hereby authorize the directors of Sports Camp to act on my behalf according to their best judgement in an emergency requiring medical attention, and hereby waive and release the camp and church from any and all liability for injuries while at camp.
Authorized Name
Space is Limited!!
Registration is not complete until payment has been recieved.
Payment must be made in person, or by mail. Online payment is not available.
For further information, call 925.210.9036