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Camper * First Last
Camper's DOB * MM / DD / YYYY
Parent/Guardian * First Last
Daytime Phone Number * ### - ### - ####
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
How did you hear about this event? *
Please list the names and phone numbers of those who are allowed to pick up your child from camp: *
Does your child have any allergies, medical conditions, or special needs? *
Waiver and Medical Release:
Please initial in the box below if you agree to the following terms - As the parent/legal guardian of the above camper, I hereby give permission for my child to participate in Afrim's Sports Action Camp. I understand that sports camps involve physical contact between campers and I assume the risks associated with my child's participation. My child has no known medical conditions which prohibit participation in this camp. I agree to hold harmless and release Afrim's Sports, Inc. and thier agents and sponsors from legal liability resulting from any injuries sustained during participation in these activities. I understand that Cans for Camp is a voluntary event and takes place from 9am-4pm on Monday, April 13th. I also understand that I will be charged for extended care if I drop my child off prior to 8:45am or pick him/her up after 4:15pm ($7 min.) In the event that my child needs medical attantion, I give permission for a licensed medical professional to treat my child. *
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