Summer Camp Enrollment Form

Summer Camp Registration
Earlybird Rate: $130
Register Before May 25th

Regular Rate: $250
CHILD INFORMATION:
Child Name*

First NameLast Name
Gender*
Male / Female
Birth Date*

MonthDayYear
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
LIABILITY & MEDICAL RELEASE
I/We blank the parent/ guardian of blank hereby release Abraham Philips and its employees, tournament personnel, and sponsors of all responsibility in the event of an accident or injury. I also consent to emergency and/or hospital service sought by employee/ tournament personnel.
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Date

MonthDayYear
Date
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Summer Camp Registration