APPLICATION FOR SPEED AND AGILITY CAMP Dates: October 1, 8, 15, 22 and 29, 2005 Time: 9:00 11:00 a'm - PowerPoint PPT Presentation

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APPLICATION FOR SPEED AND AGILITY CAMP Dates: October 1, 8, 15, 22 and 29, 2005 Time: 9:00 11:00 a'm

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I hereby authorize any emergency medical ... For more information contact Kyle Higuchi at 306-8282 or ... Please make checks payable to the Kyle Higuchi. ... – PowerPoint PPT presentation

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Title: APPLICATION FOR SPEED AND AGILITY CAMP Dates: October 1, 8, 15, 22 and 29, 2005 Time: 9:00 11:00 a'm


1
APPLICATION FOR SPEED AND AGILITY CAMPDates
October 1, 8, 15, 22 and 29, 2005 Time 900
1100 a.m.Cost 50 (Submit payment by
September 30th)
Name_____________________________________________
______ SEX M F Address_____________________
______________City___________Zip________ Parent(
s) Name_________________________________Cell
________________ E-mail Address________________
_______________________________________ Day
Phone__________________________Evening
Phone___________________ Physicians
Name_____________________ Phone__________Insuran
ce_______ Person Picking Up Player______________
____________Relationship__________ Birth
Date___/___/___ School Attending_____________
__________Grade_____ Referred By________________
_________________________________________ Sport
involved in (mark all that applies) Baseball___
Soccer___ Softball___ Basketball___
Other_________________
  • I hereby authorize any emergency medical
    treatment for my child which may be deemed
    advisable in the event of injury, accident and/or
    illness during this event. I have no knowledge
    of any physical impairment which would be
    affected by my childs participation in the
    clinic. I agree I will hold harmless, indemnify,
    defend and release Mililani High School Coaching
    Staff from any claim, I or my child may have for
    injury or damage which may result from
    participation in this event.
  • __________________________________________________
    ________________
  • Parent or Guardians Print Name Parent or
    Guardian Authorization Date
  • For more information contact Kyle Higuchi at
    306-8282 or
  • to request an application e-mail
    syadya_at_excel.com.
  • Please make checks payable to the Kyle Higuchi.
  • Mail Application Form and Check to Grand Slam
    Sports

  • 744 Kohou Street

  • Honolulu, HI 96817
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