TWCA Summer Fun Camps 2010 - St. Pius X High School



[pic]

Panther - Speed, Strength, and Conditioning Camp

St. Pius X High School

811 W. Donovan

Houston, Texas 77091

713-579-7532(school), hills@ (email)

(Please print or type)

Student Name _________________________________________________________________________

Last First Middle

Date of Birth __________________ Grade in 8/15 ________________ School ______________________ Home Phone ________________

Address ___________________________________________________________________________________________________________

Street City State Zip

Parent Name _____________________________________ Parent Name ______________________________________________

Daytime Phone ___________________________________ Daytime Phone ____________________________________________

Cell Phone ______________________________________ Cell Phone _______________________________________________

Email __________________________________________ Email ___________________________________________________

• Registration Form may be submitted by email to Stephen Hill at hills@

• Tuition for the camp is $200. The camp will begin on June 8th and end July 24th. You may pay with cash. For all payment by check, please make the check to Stephen Hill.

• Times of the camp of 7am – 9am on Monday-Thursday. (Friday, Saturday, & Sunday off) The camp will run four days a week and may adjust according to any holidays.

• FULL PAYMENT MUST BE RECEIVED BEFORE CAMPER MAY PARTICIPATE.

Emergency Contact Information

In the event of an emergency, parents or guardians will be contacted first. Please list two alternate emergency contacts.

Emergency Contact ____________________________ Relationship __________ Daytime Phone ___________ Cell Phone __________

Medical Information

Physician _________________________________ Phone ______________________

In case of an emergency, I give my permission for the above named student to be given emergency treatment at any hospital reasonably accessible. For students not enrolled at St. Pius X High School during the school year of 2013-2014, please send a copy of immunizations and a physician’s release certifying that the above named student is in good health and may participate in all activities and programs. If desired, a copy of the St. Pius X High School Health Form can be sent at your request. For a St. Pius X High School Health Form contact Stephen Hill at hills@.

Student Name ________________________________________________ Age _____ Home Phone _________________________________

Last First Middle

There is an inherent element of risk and injury that exists when students participate in activities and programs. A parent or guardian of each participant in the Panther Speed Strength and Conditioning Camp must acknowledge this risk by signing this registration form. If the registration form is not signed before the camp begins, the camper will not be allowed to participate.

I HAVE READ AND UNDERSTAND THE PANTHER SPEED, STRENGTH, AND CONDITIONING CAMP REGISTRATION FORM.

Signature ___________________________________ Relationship _____________________________ Date _______________________

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download