Camper's Name

Street Address

City

State   Zip Code   Home Telephone

E-Mail Address

Grade (Fall 2008)    Position

School

Coach

Family Medical Insurance Company

Policy #

I certify that has my permission to participate in the Ronda Shirley Volleyball Camp. I further certify that the above recreational player has medical insurance incase of emergency. I hereby grant permission to officials of the Ronda Shirley Volleyball Camp to act for me according to their best judgment in any emergency requiring medical attention and hereby waive and release the camp and Ronda Shirley and her staff from any liability for any injuries while at camp..
Signature (Parent/Guardian)
Date

Please check all the appropriate boxes below for the camps you will be attending:

Questions? Contact Coach Ronda Shirley at (620) 665-3588 or shirleyr@hutchcc.edu for more information