Summer Camp Registration
Welcome to the 2025 PV-ATL Summer Camp Registration Form!  Please fill out the following form to register for Pole Vault Atlanta's Summer Camps!

We have three camps this coming Summer!
1. June 3-4-5          10:00am - 2:00pm
2. June 17-18-19   10:00am-2:00pm
3. July 8-9-10.        10:00am-2:00pm

Payment Information: 
-VENMO = Pole_Vault_Atlanta_Acquisitions (Non-Club = $205      Club = $105 -- Absorbs some of the VENMO fees)
-CREDIT CARD  = Non-Club = $205      Club = $105 -- Absorbs some of the SQUARE fees
-CHECK Non-Club Member Price - $200       Club Members - $100
-CASH Non-Club Member Price - $200       Club Members - $100

-If you sign up for two camps = 5% off!
-If you sign up for three camps = 10% off!
-Coaches = FREE!

Matt Barry - Head Coach - 678-641-2039 
mbarry628@gmail.com
Sign in to Google to save your progress. Learn more
Email *
Which camp would you like to sign up for?
Athlete First Name
Athlete Last Name *
Today's Date -- Month/Date/Year *
MM
/
DD
/
YYYY
Preferred Email Address -- Receives all information  *
Second Preferred Email Address -- Receives all information
Athlete Email Address -- Not required -- but the athlete receives all information
Primary Phone Number *
School (please list middle or high school) *
Athlete Birthday  *
MM
/
DD
/
YYYY
Athlete Age *
Parent/Guardian Name/Primary & Emergency Contact  *
Athlete's Primary Physican if available
Does the athlete have any allergies? Please list *
Any other health conditions/issues the coaches should know about? *
Does the athlete have any previous pole vault experience -- if yes, please explain

PARENTAL CONSENT FOR TREATMENT OF CHILD


(Please be certain to sign in each of the three places and fill-in the insurance information. This is NOT 

optional.)

Parental consent for the treatment of minors in the case of illness or accident. Parental permission must

be obtained before medical treatment can be rendered to persons under 18 years of age. The following consent

from should be signed by the parent or guardian so that indicated care might be given with no unnecessary

delay. No major procedures will be performed, except in extreme emergency, without parent being notified and

fully informed. In the event that a parent does not want treatment rendered under any circumstance, the parent

should cross out the work “give: on the form below and insert the word “refuse”. If the form is not signed, it will

be interpreted as a refusal of permission.

I give permission to the physician(s) at any physician’s office, hospital, or clinic to carry out such emergency diagnostic and therapeutic procedures as may be necessary for my son/daughter, and in the physician’s

absence for the nurse on duty to render emergency care in line with standing order.


Clicking "Yes" below, you are agreeing to above information

*** Price - $200 for non-club members

*** Price - $100 for club members

Please pay upon arrival of the next practice.  We accept

-Check (preferred)

-Cash (preferred)

-Venmo  -- PVATL628 (preferred)

-Credit Card (We do not charge patrons the credit card fee)

*
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report