New Beginning For Youth Camp Registration
CHILD'S NAME:
AGE:
STREET ADDRESS:
CITY/ STATE/ ZIP:
HOME PHONE:
GRADE/SCHOOL:
HEIGHT:
WEIGHT:
GENDER:
DAY CAMP $85 JUNE 26-29, 2006
EMERGENCY CONTACT:
PHONE #
  • NO REFUND AFTER BEGINNING OF CAMP SESSION
  • PLEASE RETURN APPLICATION WITH CHECK OR MONEY ORDER TO:New Beginning For Youth PO
    BOX 353, BRICE, OHIO 43109
  • T-SHIRT SIZE (PLEASE CHECK)                YM            YL          S             M           L           XL          XXL
         **********SHOOTING CLINICS TO BE ANNOUNCED!**********
I AFFIRM THAT MY CHILD IS IN GOOD HEALTH AND ABLE TO PARTICIPATE IN ALL
PHYSICAL ACTIVITIES ASSOCIATED WITH THE CAMP'S HIGHLY ENERGETIC
PROGRAMS. I UNDERSTAND THAT THE DIRECTOR, STAFF OR ANYONE ASSOCIATED
WITH THE CAMP AND ANY HOST FACILITIES WILL NOT ASSUME RESPONSIBILITY FOR
ACCIDENTS AND MEDICAL OR DENTAL EXPENSES INCURRED AS A RESULT OF
PARTICIPATION IN THIS PROGRAM. FURTHERMORE, I HEREBY PERMIT THE CAMP
DIRECTOR T O ARRANGE FOR AND PROVIDE MEDICAL ATTENTION IN THE EVENT MY
CHILD IS INJURED.
PARENT/GUARDIAN SIGNATURE:
DATE: