Summer Camp Application

2009 Summer Camp Application

Please contact Coach Megan Greene for more information (928) 523-5649

Type of Camper
Camper First Name
Camper Last Name
Camper Address
Camper City
Camper State
Camper Zip Code
Camper Email
Parent First Name
Parent Last Name
Parent Address
Parent City
Parent State
Parent Zip Code
Parent Phone:
Parent Evening/Emergency Phone
Parent Email (for Enrollment confirmation)
Camper School
Camper Club
Camper Position
Height of Camper
Grade (Fall 2009)
Age
Roommate Request
T-Shirt Size
Insurance Company
Policy Holder Name
Policy Number
Insurance Company Address and Phone
Past Injuries
Current Health (medications)
Drug Sensitivities
Other Allergies

I verify that my child has been checked by a licensed physician and is physically able to participate in the NAU Volleyball Camp. I herby agree that I will not hold Northern Arizona University, the Board of Regents, the State of Arizona and NAU Volleyball Camp or its employees responsible for any loss, damages, or personal injury received as a result of participation. I hereby authorize the directors of the NAU Volleyball Camp to act for my child according to their best judgment in an emergency requiring medical attention. I agree to allow my child to be treated by a student athletic trainer or licensed physician (if necessary) and to assume all cost related to such treatment. I authorize my insurance company to pay benefits to NAU Fronske Heath Center or Flagstaff Medical Center. Also, I authorize the disclosure of medical information to my insurance company for the purpose of claim. I give my child permission to participate in the NAU Volleyball Camp.
I agree with the statement above (please enter your initials)