| NAME______________________________AGE:________________ |
| HOME ADDRESS__________________________________________ |
| CITY___________________________________________________ |
| STATE________________________ZIP_______________________ |
| HOME PHONE____________________________________________ |
| T-SHIRT SIZE: ADULT: S M L XL (ONE T-SHIRT PER APPLICATION) |
It is fully understood by all parties that this camp does not provide accident and health insurance or any other kind of insurance and the owners of the facility nor the instructional staff will be held responsible for accident or injury.
PARENT OR GUARDIAN:_________________________________________(signature)