Camp Registration Form

* Denotes required information.

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Camp:

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Camp Code

Camp Location

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Student's Name

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Birth Date

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Address

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City

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State

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Zip Code

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Parent's Name

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Email Address

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Home Phone

Work Phone

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Cell Phone

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In Case of Emergency Contact

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Emergency Phone

Please note any medical
conditions we should be aware of:

Additional Comments

By submitting this form I hereby authorize the staff of Player's Choice Academy to act for me in any emergency, and I hereby waive, release, absolve, indemnify, and agree to hold harmless Player's Choice Academy, P.C.A, Inc. and staff from any and all liability for any injuries or illnesses sustained during any session. I understand that this application for enrollment must be accompanied by full payment, which will only be refunded if the lessons or classes are full, and this application is not accepted or if class is cancelled.