Participant Registration Form
PeppNation Sports Leadership Camps (PeppNation) educate and develop youth nationally through athletics.

As you register your child please note that there will be several sections for your approval:
* General Participant Information to include parent/guardian and emergency contact information.
* Health Information (required by all youth service organization for the safety of the child)
* Walk-Home Permission. Allowing us to know your preference of pick-up or walk home.
* Waiver and Release. All participants must have a waiver on file in order to participate with PeppNation.
* Statement and Consent. All participants are asked to fill out surveys about their PeppNation experience and may be part of our social media news posts. Each youth must have permission to be treated or transported in case of an emergency.
Note: The following registration information will stay in our files during the calendar year and may be subject to renew after the first year of services or until you state otherwise with a written letter to PO Box 510762, Milwaukee, WI 53203 or email to PeppNationSLC@gmail.com .

By filling out and submitting this registration form you will give PeppNation permission to provide program services to your child(ren).

You hereby affirm that you are either over 18, the Parent or Legal Guardian and you release and discharge PeppNation from any and all liability resulting from your child(ren)'s participation in PeppNation activities.

Email address *
Participant Information
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
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YYYY
Gender *
Age *
Your answer
Grade *
Your answer
Ethnicity *
Street Address
Your answer
Apt#
Your answer
Zip Code
Your answer
Primary Phone Number *
Your answer
Alternate Phone Number *
Your answer
Email Address *
Your answer
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