Mega Sports Camp Registration Form
July 28- Aug 1st 5:30-8:30 810 W 4th St Dixon, MO
Child's Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Age
Grade completed
Gender
Male
Female
Sports Choice (kids pick one sport, all 4 and 5 year old kids must pick Sports Basics)
Baseball
Basketball
STEM & Art
Sports Basics (all 4 and 5 year old kids MUST be in this group)
Parent/Guardian Name
First Name
Last Name
Relationship to Child
Primary Phone
Please enter a valid phone number.
Secondary Phone
Please enter a valid phone number.
Emergency Contact Name # 1
First Name
Last Name
Emergency Contact Phone # 1
Please enter a valid phone number.
Emergency Contact Name # 2
First Name
Last Name
Emergency Contact Phone # 2
Please enter a valid phone number.
Special Concerns: Allergies, medical concerns, etc
Parent Signature
Continue
Should be Empty: