Sports Camp Registration

Athlete Information

Athlete's Name

First NameLast Name

Email

example@example.com

Birth Date

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Clinic Attending

High School Clinic July 17th 2:00 to 4:00pm grades 8 to 12 $125Middle School Clinic July 17th 5:30 to 7:30pm grades 4 to 8 $125Elementary School Clinic July 20th 5:30 to 7:30pm grades K to 4 $125

Address:

Carmela Farms, LLC
20 Moyer Road
Collegeville, PA 19426

Payments: Venmo @Ashley-Sessa-2 (last 4 digits of phone number to verify is 1844) PLEASE ADD ATHLETE'S NAME TO VENMO or check made out to Ashley Sessa. Please make payments by July 1, 2023.

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.

Waivers will be emailed to athlete's and parents for signature upon receiving registration. No athelte will be permitted to attend clinic without all waviers signed.

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.

Signature*

AS3 Clinics Registration