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basketball
Tulsa Roughnecks & Fortuna Tulsa 2019 Osage Casino & Hotel Clinic
Register for camp by completing this form. Please call 918-297-6808 if you have any problems
11
Questions
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1
Players Name
*
This field is required.
First Name
Last Name
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2
Players D.O.B
*
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-
Date
Year
Month
Day
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3
Players Gender
*
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Male
Female
Prefer not to say
Male
Female
Prefer not to say
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4
Players Current Team
(If any, answer 'none' if not on a team)
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5
Players Soccer Background
(e.g. Played recreational soccer for 4 years)
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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6
Players Medical Conditions
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7
Parent/Guardian Name
*
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First Name
Last Name
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8
Parent/Guardian Contact Number
*
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Cell / Office
Phone Number
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9
Parent/Guardian Email
*
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example@example.com
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10
Camper Liability and Health Information. I the undersigned, hereby certify that I am the parent or legal guardian of the camper. I hereby give permission for the staff of the camp to seek appropriate medical attention and for medical attention to be given in case of accident, injury or illness. In addition, I will be responsible for any and all costs of medical attention and treatment. I the undersigned, for myself, my family and heirs, waive, release and forever discharge the Camp staff, officers and representatives, from any and all liability, claims, demands or actions whatsoever arising out of or related to any loss, personal injury or property damage that may be sustained or occur during participation in camp activities or while at camp. I also understand that the Camp retains the right to use photographs of campers taken at the Camps for publicity and advertising purposes. I sign below to show my acknowledgement.
*
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Clear
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11
Date of Signature
*
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-
Date
Year
Month
Day
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12
Tags
Todo
In Progress
Done
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