Sports Camps 2018
Registration Form
Email address *
Name *
Your answer
Address *
Your answer
School *
Your answer
Grade entering in September *
Your answer
Emergency Contact *
Your answer
Emergency Contact's Phone *
Your answer
T-Shirt size - Adult Women Sizes *
You must register by June 1st to receive a T-Shirt
Camps:
Cost for all Camps: $150 | After June 1st: $175
Choose your Camps *
Please make checks payable/mail to: Mother Seton Regional High School - Sports Camp One Valley Rd, Clark, NJ 07066 Attn: Mrs. O'Boyle
Required
Proof of Health Insurance
Name of Health Insurance Company *
Your answer
Insurance # *
Your answer
HEALTH INFORMATION
Athlete's Name *
Your answer
Email address *
Your answer
Age *
Your answer
Date of Birth *
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Parent/Guardian *
Your answer
Parent/Guardian's Phone *
Your answer
My daughter had her last physical exam on: *
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Health history and immunizations are up to date. There are no apparent contraindications to participation in camp activities.
Exceptions, special problems, unusual allergies that should be known and shared with appropriate camp staff members include:
Other exceptions, special problems, unusual allergies that should be known and shared with appropriate camp staff members include:
Your answer
I hereby release, indemnify and hold harmless Mother Seton Regional High School, and the Roman Catholic Archdiocese of Newark and/or personnel, clergy, agents of same, from any and all claims and liability relating to any kind of personal injury damage due to participation in this camp. I certify that my child is in good health and is able to participate in all activities. If any attention is required for illness or injury, I give my permission to a staff member to arrange for such care. I understand that I am liable for any expenses which are not covered by my insurance policy which is in force at the time of injury. I give consent for my child to be photographed, videotaped or filmed while participating in camp activities and for the resulting images to be used by Mother Seton Regional High School for promotional purposes.

I request that the staff provide first aid, medical treatment or hospitalization in the event of an unexpected medical emergency, accident or injury.

Signature of Parent/Guardian *
By typing your legal name below you acknowledge to electronically sign this form:
Your answer
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This form was created inside of Mother Seton Regional High School.