ATHLETES IN ACTION

Participant(s)

Last Name

First Name

First Time

Allergies, Medical Conditions, or Pertinent Information?

Age

Birth Date

Fee

Child 1

Child 2

Child 3

Child 4

Child 5

MAIN CONTACT PERSON: (Please Circle One) Father / Mother / LEGAL Guardian - CAN NOT be just a friend or relative.
Name *

Last Name First Name
Main Contact # *

Area Code Phone Number
Email *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
EMERGENCY CONTACT (Other Than Main Contact):
Name *

First Name Last Name
Emergency Phone # *

Area Code Phone Number
Relationship to Camper(s) *
ALTERNATE ADULT APPROVED FOR PICK-UP (If necessary):
Name

First Name Last Name
Relationship to Camper(s)
HOW DID YOU HEAR ABOUT THE EVENT? (Check all that apply)

Church Prior Event Friend/Family Street Sign AIA Website Facebook Email Bridgefest Poster Radio
Should be Empty:

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