2010 Alter Volleyball Summer Youth Camp
REGISTRATION FORM

INSTRUCTIONS
1) TYPE INFORMATION INTO THE FORM BELOW
2) PRINT THE COMPLETED FORM - THIS IS NOT AN ONLINE REGISTRATION!
3) SIGN & DATE THE FORM
4) MAIL FORM & PAYMENT TO:  Tina Jasinowski - 94 Lownes Ct. - Springboro, OH 45066
5) MAKE CHECKS PAYABLE TO: Tina Jasinowski


CAMP REGISTRATION (CHECK ONE SESSION) - PLEASE COMPLETE MULTIPLE FORMS FOR MULTIPLE REGISTRATIONS!
BOTH OF THESE SESSIONS ARE FULL - WE ARE ACCEPTING REGISTRATION FOR WAITING LIST SPOTS ONLY!
INTERMEDIATE #2
     JULY 26-29 (Mon-Thu)
     8:30 am-12:30 pm
     COST: $80
    WAITING LIST ONLY!
ADVANCED
     JULY 26-29 (Mon-Thu)
     1:00-5:00 pm
     COST: $80
    WAITING LIST ONLY!

PLAYER INFO
Name:    Gender: Female   Male

School in 2010-2011:    Grade in 2010-2011: 

T-SHIRT SIZE
Youth Medium (10-12)  Youth Large (14-16)  Adult Small  Adult Medium  Adult Large  Adult XL

PLEASE NOTE: T-SHIRTS HAVE ALREADY BEEN ORDERED, WE WILL DO OUR BEST TO GET THE SIZE YOU SELECT!

CONTACT INFO
Parent Name(s):    Email: 

**PLEASE INCLUDE AREA CODE**
Home Phone:    Cell Phone:    Cell Phone: 
Other Phone Numbers: 

Street Address:    City:    State:    Zip: 

EMERGENCY MEDICAL SECTION
In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for the administration of any
treatment deemed necessary by the medical providers listed below. If these designees are not available, I further consent to the
transfer of my child to the hospital listed below (or any reasonably accessible hospital).

Physician:    Dentist:    Hospital: 

LIABILITY RELEASE SECTION
I, the undersigned, as a parent/guardian of: , a minor, ask that he/she be admitted to
participate in the Alter Volleyball Summer Camp. In consideration of this admission, I do agree to release, discharge, and hold
harmless Alter High School and South Metro Sports, their officers, agents and employees of and from all causes, liabilities, claims,
damages, or demands whatsoever on account of any injury or accident involving said minor during minor's attendance and
participation in the Alter Volleyball Summer Camp or during activities held in connection with the camp.

Parent/Guardian Signature: ___________________________________________  Date: ________________

THIS IS NOT AN ONLINE REGISTRATION - PLEASE PRINT THE FORM & MAIL IN WITH PAYMENT!