REGISTRATION

Application for enrollment- Jr Cruiser Volleyball Program 2018

Name__________________________________School____________________

Grade as of Sept. 2018____________

Age_________

T-Shirt Size: XS S M L XL

ALL PARTICIPANTS MUST HAVE MEDICAL INSURANCE

Insurance Company______________________________
Doctors name and phone number________________________________

Parent Release for Medical Treatment

I approve of my child's attendance at the Eatonville Jr Cruiser Volleyball Camp and certify that
she is in good health and able to participate in the program of activities. I authorize the clinic
staff to attend to any health problem or injury my child may incur while attending the camp. I
hereby release the eatonville Girl’s Volleyball program, its employees, or agents from any and
all liability that may arise out of my child's participation in the camp. I acknowledge that I am
responsible for any and all medical expenses due to my child's illness or injury.

Parent’s or Guardian’s name_____________________________________

Parent’s Signature_____________________________________________
Address_____________________________________________________
Email_______________________________________________________
Phone number we can reach while child is in camp___________________

Emergency contact and phone number in case of emergencyand parent/guardian can not be
reached during camp hours:

Contact Name___________________________Relation________________
Phone number___________________________