Camper Name

Shirt Size

Camper Age

Parent/Guardian

Address

City

State CAALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip

Phone

Your Email

Emergency Contact

Phone

I hereby release Chico Rugby Foundation and any host organization from any and all claims and liability of any kind of personal injury or property damage due to participation in this camp. I understand that participation in sports camps include physical contact and certify that my child is in good health and able to participate in all activities. I agree to notify the coaching staff of any preexisting medical or psychological conditions. If attention is required for illness or injury, I give my permission to a staff member for such care. I give my consent for my child to be photographed or video taped while participating in camp activities and for me resulting images to be used by Chico rugby Foundation for promotional purposes. If returned unpaid I authorize my account to be electronically debited for both the check amount and returned check fee.

By checking this box you agree to and abide by the terms stated above.

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