Emergency Medical Release & Waiver form MUST be completed prior to 1st day of Camp
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Name: |
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| Address, CITY | |
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BIRTH DATE |
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Grade |
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School |
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Home Phone: |
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| Parent/Guardian name | |
| Emergency # | () - |
| Emergency Contact | |
| Experience, X one | Beginner Intermediate Skilled |
| Position Played, X one | Middle Outside Setter Back Row |
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Email address: |
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Comments: |
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PRINT THIS PAGE AND MAIL IT IN WITH YOUR PAYMENTS
365 North Abbe Rd
Elyria Oh 44035
All Checks payable to Dave Cross
