CAMP

REGISTRATION FORM

Name:
Age:
Grade:
Address:
City:
Zip:
Parent/Guardian Name:
Home Phone:
-- ---Mobile Phone: --
Email Address:
Emergency Contact:
Medical Condition(s):
Current Medications:
CAMP FEE: $50
($60 after 6/1/09)
Register now or at camp
Complete, print and mail to...
Levi Mumma
c/o CV Athletic Deptartment
Cumberland Valley High School
6746 Carlisle Pike, Mechanicsburg, PA 17050

MAKE CHECKS PAYABLE TO CVMFA

I understand that football can be a dangerous activity and therefore
I hold harmless the Cumberland Valley School District, Jon Ritchie, the
coaches, volunteers and sponsors for any injury that may occur to myself
or my child while participating in the Jon Ritchie Next Level Football Camp.

Signature of Parent/Guardian