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Please fill out the form below to register for the
2010 RAD CENTRAL PA FIELD HOCKEY CAMP

Players Name:
Parent/Guardian Name:
Address:
City:
State:
Zip Code:
Campers Cell:
Parent/Guardian Cell:
Primary Contact Email: (Required)
School:
Age @ Camp:
Grade Fall '10:
Position:
Playing Level:
I hereby give permission for my child to be medically treated for injuries or illness during participation in the Reach Athletic Development, llc field hockey camp. I also acknowledge that the camper above is healthy and has no physical problems that would prevent participation in the camp. Primary insurance coverage rests with the camper, parents and or guardian.
Insurance Company:
Insurance Policy Number:
Please list any special physical conditions (Allergies, etc.):
Parent Signature (If under 18):
Date:
Please choose payment method:
(Instructions on the next page)
 Paypal
Mail Payment





Registration for 2010 RAD CENTRAL PA FIELD HOCKEY CAMP
 
757 - 450 - 1086

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