camp registration form

2015 Guthrie Youth Cheer CAMP
www.guthrieyouthcheer.org
Make Checks Payable to Guthrie Youth Cheer
Registration Fee $40 (Includes T-Shirt & Bow)
Form and fee due by May 1, 2015
P.O. Box 544, Guthrie, OK 73044
CAMP will be Located at Highland Park June 5-6 from 9-noon
CAMP is available for Kindergarten - 6th grade
CAMPER Information
Last Name
First Name
Nick Name
Date of Birth
Street Address
City
Zip Code
Phone
Grade as of Fall 2015
T-SHIRT SIZE YSM (6-8), YMD (10-12) , YLG (14-16), AD -SM (4-6), AD -MD (8-10)
SHORT SIZE YSM (6-8), YMD (10-12) , YLG (14-16), AD -SM (4-6), AD -MD (8-10)
Parent/Guardian Emergency Contact Information (please be complete as possible)
Parent/Guardian Full
Relationship to
Work Phone
Cell Phone
Email Address
Parent/Guardian 2
Relationship to
Work Phone
Cell Phone
Email Address
EMERGENCY AUTHORIZATION:
In the event I cannot be reached in an emergency, I hereby give permission to physicians coaches and/or
Board members of Guthrie Youth Cheer to hospitalzie and secure proper treatment.
EMERGENCY CONTACT INFORMATION
Name:
Day phone number:
Evening phone number :
Physician/Family Doctor:
Doctor's Phone:
Additional, I am giving Guthrie Youth Cheer Association (GYC) permission to reproduce, copy and publish photographs
and video taken at GYC events for promotion use on the GYC website or any GYC printed collatteral, unless I provide
written notification to GYC stating other wise.
All REGISTRATION FEES MUST BE PAID IN FULL BY 5/1/2015 OR PARTICPATION IS NOT GUARANTEED ________ (initials)
I hereby certify that all of the above information is true and I understand that any misstatement of the facts may
result in my child's inelligibility to participate in the Guthrie Youth Cheer Camp.
X
Parent/Guardian Print Name
Amount paid: ____________
Date
X
Parent/Guardian Signature
For GYC officer use only
Date: __________
Method (circle one):
cash
OFFICER INITIALS
Date
check#