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