Camp Clearance Form Return this form to:

Wenatchee Athletic Department c/o Basketball Camp 1101 Millerdale Avenue Wenatchee, WA. 98801

Make checks payable to:

WHS ASB

Cost:

$50.00 (includes camp t-shirt, please circle size)

Camp Dates and Schedule:

April 22nd to April 25th K – 3rd grades ……. 3:30 PM to 5:00 PM 4th – 6th grades …….3:30 PM to 5:30 PM

YL

S

M

L

XL

Participant Name: _________________________________________ Parent Phone: ________________________________ Address: _____________________________________________ Grade Entering: ______ Birth Date: __________________ City: _________________________________________ Parent Email: ___________________________________________ School Attending: _____________________________________________________

Emergency Contact Information: Name: _________________________________________ Relation: __________________ Phone: _____________________ Medical Insurance Co: _________________________________________ Policy #: ________________________________ My child is in good physical condition and is cleared to participate in this activity. Medical/physical information we should be aware of: __________________________________________________ _____________________________________________________________________________________________ I give permission for my child to participate in the ASB sponsored camp and hold harmless the WHS ASB and any representative thereof from any and all liability that may arise from my child’s participation in this activity.



I understand that injuries can occur during participation in this activity. I recognize that conditioning, nutrition, proper technique, safety procedures and well-fitting equipment are important aspects of this training program. I authorize the staff of this WHS ASB activity to obtain medical care if necessary and acknowledge that I am responsible for any and all medical expenses due to an injury or illness that occurs while at camp.

Parent Name: _____________________________________________________________ Date: _______________________



Parent Signature: ________________________________________________________________________ *Visit the WHS Athletics website to print additional registration forms.



Athletic Office Use Only

Date Received:

Payment Received: Check # (if applicable):



Campamento Formulario de Autorización Regrese esta forma a:

Wenatchee Athletic Department c/o Basketball Camp 1101 Millerdale Avenue Wenatchee, WA. 98801

Enviar cheques a nombre de:

WHS ASB

Costo:

$50.00 (incluye playeras de campamento, por favor circule la talla) YL S M L XL

Fechas y horario de campamento:

Abril 22nd to Abril 25th K – 3rd grado …….. 3:30 PM to 5:00 PM 4th – 6th grado ……. 3:30 PM to 5:30 PM

Nombre de participante: ________________________________ Número telefonico de padres: ________________________ Domicilio: _________________________________________ Proximo Grado: ______ Fecha de nacimiento: ____________ Ciudad: ______________________________________ Correo electronico: _______________________________________ Escuela asistir: _____________________________________________________

Información de contacto de emergencia: Nombre: __________________________________ Relación: ________________ Número teléfonico: _________________ Compañia de seguro médico: _____________________________________ Número de polica #: ______________________ Mi hijo esta en buena condición fisica y puede participar en esta actividad. Información médica/física que deberiamos saber: _____________________________________________________ _____________________________________________________________________________________________ Le doy permiso a mi hijo para participar en un campamento patrocinado por ASB y exumo de responsibilidad a la escuela de Wenatchee High School y algun representante de ella por problemas que puedan derivar la participación de mi hijo en esta actividad. Yo comprendo que heridas pueden ocurrir durante la participación en esta actividad. Yo reconosco que el entrenamiento, nutrición, técnicas adecuadas, procedimientos de seguridad y equipamiento bien ajustado son aspectos importantes de este programa de entrenamiento.



Yo autorizo a Los empleados de Wenatchee High School para obtener cuidado medico si es necesario y comprendo que soy responsible por todos los cargos financieros que sean causados por alguna herida o enfermedad que ocurran en el campamento.

Nombre de padre: _________________________________________________________ Fecha: ______________________

Firma de padre: ________________________________________________________________________ * Visite el sitio web WHS Atletismo para imprimir formularios adicionales.



Athletic Office Use Only

Date Received:

Payment Received: Check # (if applicable):