Summer Camp Detailed Registration Form June 17th and 18th

Darrell Pearson Volleyball All Skills Camp Registration

The camp will be run by Coach Darrell Pearson. All sessions will be held at the Titan Sports Complex. 101 East 81st St S, Tulsa, OK 74132 *All Skills Camp 7th-9th Grade *June 17th and 18th 8-10am *Cost is $80
Athlete Information
Athlete's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender
Parent/Guardian Information
Name

First NameLast Name
Home Number

Area CodePhone Number
Cell Number

Area CodePhone Number
E-mail
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the athlete prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I, the undersigned, give permission for my child to participate in the Pearson Volleyball Camp. I release the camp director, Darrell Pearson, staff, and Titan Sports Complex from any liability for injury or illness related to camp activities.

Applications must be received by June 16th due to limited spaces. Walk-up registration will be on a space available basis. Please make checks payable to: Darrell Pearson Mail payment to 4216 W Kent Ct, Broken Arrow, OK 74012. For more information, contact Darrell Pearson, darrellpearson1@hotmail.com or 918-636-7294.
Signature
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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Darrell Pearson Volleyball All Skills Camp Registration