Summer Camp Registration Form

2022

All Star Development Clinic Registration

July 11 - 14

9:30 am - 2:30 pm

Hampshire College - Amherst, MA

www.massfrenzy.org

Athlete Information

Player Name *

First Name Last Name

Reversible Size *

Date of Birth *

Current School (Fall 2021) *

Grade Level (Fall 2021) *

Guardian / Parents Names *

First Name Last Name

Email

example@example.com

Address *

Street Address

Street Address Line 2

City

Postal / Zip Code

Phone # *

Area Code Phone Number

Additional Phone

Area Code Phone Number

E-mail *

Emergency Contact & Health Insurance Information

Emergency Contact's Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Is the player fully covered by health insurance ? *

Yes No.

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? *

Yes No.

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 *

Yes No

Parent / Guardian Name *

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

My Products *

2022 Registration Fee $ 200.00

Enter coupon

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Release of Liability

Pay Camp Fee