First Name *

Last Name *

Date of Birth *

Gender *

Dirección

Street Address

City

State/Province/Region

Country

Postal Code

First Name *

Last Name *

Relationship to the Participant *

Representative's Phone Number *

Emergency Contact First Name *

Emergency Contact Last Name *

Relationship to the Participant *

Emergency Contact Phone Number *

Insurance Company

Policy Number

Doctor's Name

Do you have any medical condition or physical limitation?

Describe the condition

Do you need to take medication during the camp?

Medication Administration Instructions

Do you have any food allergies or restrictions?

Describe the allergies or restrictions

Full Name *

Indicate the relationship to the participant *

Authorized Person's Phone Number *

Guardian's Full Name *

Date *

Guardian's Signature *

Clear

I certify that I am the parent, mother, or legal guardian of the participant, that I have read and fully accept the Terms and Conditions of the Bright Next: Champions Volleyball Camp, in including the assumption of risk, the release of liability, the authorizations, and all policies established herein. I understand that this electronic acceptance has the same legal validity as a handwritten signature, in accordance with applicable law.