2010 UMS-WRIGHT SPORTS CAMP REGISTRATION FORM

Please use one registration form and one check per camper per camp

 Duplicate this form as needed

(Please print)

NAME OF CAMP ATTENDING:________________________                         _

NAME OF CAMPER:                                                                                                   

ADDRESS:_________________________________________                                       

CITY:__________________ZIP:_____________AGE:_______

EMAIL ADDRESS:  ____________________________________________ HOME PHONE: _________________CELL PHONE: ___________________

GRADE IN FALL OF 2010 ______  DATE OF BIRTH: ______________

T-SHIRT SIZE (please circle)  YS       YM    YL    AS     AM     AL     AXL

PARENT/GUARDIAN NAME:______________________________________

BUSINESS PHONE: ______________ CELL:                                                

PERSON TO CONTACT IN CASE OF EMERGENCY:

NAME:________________________________________________________________ Relationship to Camper: _________________________________________

PHONE: ________________________

$25 NON-REFUNDABLE DEPOSIT DUE WITH COMPLETED FORM AS SOON AS POSSIBLE.  BALANCE IS DUE ON THE FIRST DAY OF CAMP.  PLEASE MAKE ALL CHECKS PAYABLE TO UMS-WRIGHT SPORTS CAMP. PLEASE INDICATE CAMP NAME ON YOUR CHECK. YOU MAY PREPAY IN FULL IF YOU CHOOSE TO DO SO. 

I hereby consent for my child to participate in camp activities and release UMS-Wright from liability for any accident or misfortune not the result of those in authority.

_______________________________________Date __________________           

           PARENT/GUARDIAN SIGNATURE

PLEASE RETURN COMPLETED FORM(S) WITH

REGISTRATION FEE(S) OR CAMP FEE(S) TO:

UMS-WRIGHT SUMMER SPORTS CAMP

c/o Molly Nordmann

65 Mobile Street

Mobile, AL  36607