2019 Gold Star Summer Camp Registration
Email address *
Summer Camp *
First Name *
Your answer
Last Name *
Your answer
Gender *
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Date of Birth - MM/DD/YYYY *
Your answer
Phone Number - Cell *
Your answer
Emergency Phone Number *
Your answer
Parent First Name *
Your answer
Parent Last Name *
Your answer
Email Address *
Your answer
T-Shirt Size *
Allergies *
Your answer
Medical Condition *
Your answer
Players Physician *
Your answer
Physician Phone Number *
Your answer
Medical Insurance Company *
Your answer
Policy Holder *
Your answer
Policy Number *
Your answer
Group Number *
Your answer
How Did you hear about us? *
Promo Code
Your answer
Medical Release Form
I do hereby release and discharge Gold Star Sports and associates with Gold Star Sports for all accidents and medical or dental expenses incurred as a result of participation with Gold Star Sports. The above named applicant is in good health, and has my permission to participate in the physical activities of the rigorous Gold Star Sports program. In the event of an emergency or injury/illness, I grant permission for the applicant to be given treatment by a medical professional. I will assume all responsibility for payment of any uninsured cost incurred. I hereby irrevocably authorize Gold Star Sports to edit, publish, or distribute the photograph/Video for purposes of publicizing the Gold Star Sports programs.

Gold Star Sports will not be held liable for any injury. All players must have their own health insurance. By participating in the above program I understand that I am responsible for all payments and that all payments are non-refundable.
I have read and Understand the above? *
Electronic Signature *
Your answer
Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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