REGISTRATION FORM
2011 VIKING VOLLEYBALL CAMPS
Return the form with check or money order payable to KIWANIS CLUB OF OLD MISSION to:
SM West Viking Volleyball Camps c/o Coach Ryan Call 621 S. Penrose Lane Olathe, KS 66062
PARTICIPANT NAME ___
GRADE 2011/2012 T-SHIRT SIZE
(Adult: S, M, L, XL)
CHECK THE SESSION YOU DESIRE:
High School Camp ~ Grades 9-12 ~ June 27-June 30 3-6 pm (cost: $75.00 before 6/12 and $85.00 after 6/12)
Little Viking Camp ~ Grades 2-8 ~ June 28-June 30 6-7:45 pm (cost: $30.00 before 6/12 and $40.00 after 6/12)
***Campers grade is for the 2011-2012 school year***
The undersigned states that he/she understands that the Participant will engage in an athletic activity and that there is potential risk of injury. The undersigned has examined the potential risks, assumes the risks and understands and agrees that the school district, the coaches, the Kiwanis Club of Old Mission, Mission and Kiwanis International and their members; and the employees, agents and representatives of any of them, are not and shall not be responsible for or liable for any illness or injury to person or damage to property resulting from the activity in which the Participant is enrolled, and the Participant and the undersigned hereby forever release and hold harmless all of the above described persons or entities from any and all claims of any kind that the Participant, the undersigned, or their respective heirs, executors, administrators or assigns may have or claim to have resulting from participation in said activity.
I HAVE READ AND UNDERSTAND THE WAIVER AND RELEASE STATEMENT.
[PARTICIPATION IS NOT ALLOWED WITHOUT APPROVAL OF ALL LEGAL CUSTODIANS]
X_____________________________________________________ ____________________________ _____________________________ Signature of Parent or Guardian Day Phone Evening Phone
________________________________________________________________________________________________________________ Street Address City Zip Code
