SJ Girls Track & Field Camp Registration

Fill out Form (type in info) and click on the print button below

First Name: Middle Initial: Last Name:

Mother's first and last name

Father's first and last name

Guardian's first and last name

Street Address:

City: State: zip code

Phone: Grade Fall 2008: Age

Emergency Contact:

Buidling/School:

check yes or no below:

1. contact lenses? Yes No

2. prior injuries? Yes No

3. medical problems? Yes No

if yes to questions 2 or 3, please specify:

I hereby consent to emergency medical treatment by the Girls Track &Field Camp Staff and act in my behalf in authorizing emergency medical attention beyond that maintained by camp. I hereby waive and release the camp, it's affiliates and South Jefferson Central School from any and all liability for injuries incurred while at the camp or arising from travel to or from the camp. Campers will be responsible for medical costs and/or damages caused by the camper.

parents signature and date must be handwritten not typed:

_________________________________________________________________

Parent's Signature

________________________________________________

Date

Send Application and money to:
Julie Storms
Girls Varsity Coach
10546 Wright St Road
Adams, New York 13605

Checks payable to: South Jeff Varsity
Club Registration is due July 9, 2007

checks only