WolfPackers For Christ

Training Sessions
Monday, Wednesday, Friday

2013 WolfPackers For Christ Information

Name____________________________________________________________ Age_________
Address________________________________________________________________________

5pm-7pm
Starts Monday, June 3, 2013

Location
Join Facebook page (Wolfpackers for Christ)
for details on location.

Ages
8 12 years old
Coaches
Devin OConnor
jdoconno@ncsu.edu
Garrett Leatham
gvleatha@ncsu.edu

Session Information
$25.00 per child each
session
*Checks or Cash

Parent/Guardian______________________________________________________________
Phone#_________________________________ 2nd Phone______________________________
Emergency Contact______________________________________________________________
Emergency Contact Phone #____________________________________________________
Persons Authorized to Pick Up WolfPacker
Name__________________________ Name___________________________
Name__________________________ Name___________________________
Payment Insurance Yes No If yes, please provide the following Info:
Enclosed
Company________________________________________
Policy Number____________________________________
Parent/ Guardian Authorization
I certify that I have received any and all information that I deem necessary for my child
to participate in the WolfPackers for Christ Training Sessions identified above. Also, I
agree to assume all risks of his participation in the programs activity and agree to hold
harmless Devin OConnor and Garrett Leatham or any other volunteer against any liability
claims, damages or expenses arising from my childs participation in the WolfPackers for
Christ Training Session. Finally, I authorize the coaches of the WolfPackers for Christ to
secure any emergency medical treatment necessary to treat my child in the event that it
is deemed necessary by the coaches of WolfPackers for Christ Training Session.

Parent/Guardian_________________________________________ Date_________________________