Summer Camp Detailed Registration Form

LUHI 2021 Summer Strength and Speed Camp

June 7-August 5 - Only for Enrolled 2021-22 LuHi Students
Athlete Information
Athlete's Name

First Name Last Name
Birth Date

Month Day Year
Grade
Sport interest (if any)
Gender

Male Female
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian Information
Name

First Name Last Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First Name Last Name
Relationship
Phone Number
Alt. Phone 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 hereby give my approval for my child’s participation in any and all activities prepared by Lutheran High School during the selected camp. In exchange for the acceptance of said child’s candidacy by Lutheran High, I assume all risk, illnesses and hazards incidental to the conduct of the activities, and release, absolve and hold harmless LUHI and all its respective officers, agents, and representatives.

In case of injury or any illness to said child, I hereby waive all claims against Lutheran High, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
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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Summer Strength and Conditioning
$ 150.00

Total

$ 0.00
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LUHI 2021 Summer Strength and Speed Camp