Name:____________________________________________________________________

Address:__________________________________________________________________

Home Phone #___________________________________________________________

Emergency #______________________________________________________________

Email Address______________________________________________________________

School____________________________________________________________________

Birth date__________________________________________________________________

Mother's Name_____________________________________________________________

Father's Name______________________________________________________________

T-shirt size (youth)___________________________________________________________

Make checks payable to:  Hall of Fame Sport Camps

Mail to:  Hall of Fame Sport Camps, 2815 Lowridge Ct #6 Missoula, Mt.59808

I hereby authorize the staff of Hall of Fame Sports Academy to act for me according to their best judgment in any emergency requiring medical attention and hereby waive and release the camp from any and all liability for any injuries or illness that incurred while at Hall of Fame Sports Academy.  I have no knowledge of any physical impairment that would be affected by the above named campers participation in the camp programs.

Parent signature required:____________________________________________________

Date:_____________________________________________________________________

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