National Groups Summer Camp 2019

Team (required):
—Please choose an option—Senior GroupJunior Group

Name of Child(required):

Date of Birth (required):
(mm/dd/yyyy)

Age (required):

Names of Legal Guardians(required):

Mailing Address (required):

Home Phone (required):

Guardian #1 Cell (required):

Gurdian #2 Cell (required):

Email (required):

Medical Issues or Concerns:

Emergency Contact (during camp):

Name (required):

Phone (required):

I have read and agree to the terms presented in the Waiver of Liability

I have read and agree to the terms presented in the Permission slip

I have read and agree to the terms presented in the Athlete Media release And I give permission to: Photographic and Digital Images of my childVideo images of my childI do not give permission

Message / Remarks:

Signature (required):