SP Volleyball Summer Camp 2018 Registration

Dates: June 11, 12 and 13 Times: 8:30am – 4:00pm Cost: $75.00 per camper

Fill out form completely below and either mail payment or bring on first day of camp

For more information, please contact Coach Deyton at ddeyton@rhmail.org

What to Bring:

Volleyball shoes ( new shoes can cause blisters

Kneepads

Socks (may want to bring a pair to change into during the day)

Extra shirts (to change during the day)

Camp Provides:

Lunch

Snacks

Drinks

Do Not Bring to Camp:

Jewelry

Other Valuables

Camp is not responsible for lost articles

Registration for Volleyball Summer Camp 2018 June 11-13 Grades 7-12

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Emergency Phone*
Email*
Grade Next Fall*
School*
Physical -*
Current Physical required
Parent Consent/Medical Form
In order to enable health facilities in the area to provide prompt care to your child, please complete this consent form. This will enable us to help your child without delay in the event of an emergency
Name of Camper
First Last
Birth Date of Camper
Guardian's Name/Relationship*
Allergies*
- NO
- YES
Any allergies/drug allergies
If Yes to Alleriges, please describe*
Please describe all allergies
List All Medication*
Please list all current medication
Date of Last Tetanus Immunization
In case of emergency:
Fathers cell #*
Mothers cell #*
Other emergency contact - Name
Other emergency number
Insurance Company Name*
Policy #*
Policy Holder Name*
Agent
Medical Release
I/We, the undersigned hereby certify that I (we) am (are) the parent or legal guardian of the camper. I hereby give permission for the staff of the camp, during the period of the camp, to seek appropriate medical attention for the camper, and for medical attention to be given and for the camper to receive medical attention in the event of accident, injury, or illness. I will be responsible for any and all costs of medical attention and treatment and have medical insurance to cover these costs.
Parent/Guardian Signature*

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