"Game Changers" Pro Youth High School Volleyball Camp

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*Instruction from Coaches and players from: The University of Texas at El Paso

**Camp is open to any and all, according to age/grade noted and space available**

Due to limited space (first come first serve) per Volleyball Camp Completely filling this Electronic Form will save your spot on the Volleyball Camp you select below. To complete registration a hard copy Parental Consent/Medical Release Form is required before or by day of Check-In. Parental Consent forms can be obtained by your High School coach or Email: RafaelRamirezCo@Gmail.com

All Volleyball Camps Check-In 5:30 pm - 6:15 pm. Camp Starts promptly at 6:30 pm and ends at 8:30 pm.

Camper First Name *

Camper Last Name *

Camper Birthdate *

YYYY

School *

Grade Fall/Spring 2018-2019 *

9th

10th

11th

12th

Position *

First Name Primary Emergency Contact of Parent/Legal Guarding *

Last Name Parent/Legal Guardain *

Home Address *

Mobile Phone *

Parents/Legal Guardian Email *

Primary Emergency Contact Parents/Legal Guardian Place of Employment *

Parent/Legal Guardian Place of Employment *

Place of Employment Contact Number *

Release Form/Emergency Information: As a custodial parent or court-appointed guardian of (Write In Below Box volleyball players name), I do for both of child’s parents, for child and child’s heir and successors, release “El Paso Game Changers Pro Youth Sports Camps” and any of its agents, employees, or staff from all claims arising out of or connected with the child’s participation in any of the “El Paso Game Changers Pro Youth Sports Volleyball Camp” activities. I provide this release because I am mindful that athletics, physical training and competition can be a dangerous undertaking regardless of how careful or prudent any person, firm, or facility might be. Furthermore, I give permission to the staff of “El Paso Game Changers Pro Youth Sports, Ysleta ISD or UTEP Volleyball affiliates” to treat child or arrange for medical care or treatment deemed necessary. If circumstances permit, the staff will attempt to communicate via telephone with the following emergency contacts for child.

Volleyball Players Name *

By printing name as parent/legal guardian you accept and understand the statement above. *

In the event neither emergency contact can be reached, or if the urgency of the situation requires immediate attention without prior telephone contact, “El Paso Game Changers Pro Youth Sports” Volleyball Camp” staff may arrange for medical treatment at the expense of parent or guardian signing form by filling parent/legal guardains name.

By printing name as Parent/Legal Guardian you accept and understand statement above. *

Health Insurance Information

Name of Insurance *

Group Number *

Identification Number *

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