2012 Dolphin Volleyball Camp and Clinic Registration

____February 21-22 from 9:00-12:00 for boys and girls(ages 9-14)

Name: _______________________________________________________________________________

Phone_____________________________

Address:____________________________City/Zip: _____________________

Age: ______ DOB:________ Grade: ________ School: ___________________

Playing Experience:__________________________________________________

Please note any medical condition:_____________________________________________________

Insurance Company:______________________Policy # ____________________

Doctor's Name and #:_________________________________________________

Emergency Contact:___________________________________________________ 

I hereby authorize the staff at Dolphin Volleyball Camps to act for me

according to their best judgment in any emergency requiring medical

attention and hereby waive and release the Dolphin Volleyball Camps from any

injuries or illness while at camp. The camp staff has my permission to

seek any emergency treatment necessary for my child while in attendance at

the camp named above. 

Parent/Guardian Signature: _____________________________________Date:_________________

for Dolphin Volleyball Camps print this form and make check payable to San Francisco Day School-SFDS and send to:

Have fun, go Dolphins!

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