APPLICATION

 Emergency Medical Release & Waiver form MUST be completed  prior to 1st day of Camp

Name:

Address, CITY
Zip:

BIRTH DATE

Grade

School

Home Phone:

() -

Parent/Guardian name
Emergency # () -
Emergency Contact
Experience, X one Beginner Intermediate Skilled
Position Played, X one  Middle Outside  Setter Back Row

Email address:

Comments:

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365 North Abbe Rd

Elyria Oh 44035

All Checks payable to Dave Cross

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