2023 All-Star Development Camp Registration

2023

All Star Development Camp Registration

Week 1 - June 26 - 29

Week 2 - July 10 - 13

9:30 am - 2:30 pm

Hampshire College - Amherst, MA

www.massfrenzy.org

Athlete Information

Player Name*

First NameLast Name

Choose Your Session(s)*

Reversible Size*

Date of Birth*

Current School (Fall 2022)*

Grade Level (Fall 2022)*

Guardian / Parents Names*

First NameLast Name

Email

example@example.com

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Phone #*

Area CodePhone Number

Additional Phone

Area CodePhone Number

E-mail*

Emergency Contact & Health Insurance Information

Emergency Contact's Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Is the player fully covered by health insurance ?*

YesNo.

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to give consent for the facility to secure any and all necessary emergency medical care for my child.

Do you give consent for emergency medical treatment?*

YesNo.

Release of Liability

Although the safety of all sport activities is our primary concern, all athletic activities contain a level of risk for injury. I hereby expressly assume the risk of injury, and/or illness arising from any cause related to the player's participation in the associated athletic activities, and agree to waive the right to pursue any claim against Mass Frenzy, Inc. and its staff and coaches.

I have read and agree to the above conditions*

YesNo

Parent / Guardian Name*

Your name will act as an electronic signature for above terms.

My Products

Single Week Registration Fee$200.00

Two Session Registration Fee$350.00

Enter coupon

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Release of Liability

Pay Camp Fee