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-342900-349250KC LADY JAGS 2012 VOLLEYBALL CAMP00KC LADY JAGS 2012 VOLLEYBALL CAMP 1025892444500Saturday July 28, 2012@Southeast Community Center-657860304800Fee Includes: Snack & a Bottle of Water at break, Camp Tee and a Gift.4000020000Fee Includes: Snack & a Bottle of Water at break, Camp Tee and a Gift.4201 E 63rd St KCMO 641323629024-10010:00am-2:30pmCost: $50 per playerAges: 10-16General Information:Check-in will begin at 9:00amRegistration Deadline IS: Monday July 16th, 2012 (After deadline there is a $10 late fee) CAMP INSTRUCTORS: THE KC LADY JAGS COACHES, SOME COLLEGE PLAYERS AND SOME AREA HIGH SCHOOL COACHES. 342900-108013500-85725-425450KC LADY JAGS 2012 VOLLEYBALL CAMP REGISTRATION FORM00KC LADY JAGS 2012 VOLLEYBALL CAMP REGISTRATION FORM4543425203200Check shirt size: Youth Med 10-12 Youth Large 14-16 Adult Small Adult Med Adult LargeAdult X-LG00Check shirt size: Youth Med 10-12 Youth Large 14-16 Adult Small Adult Med Adult LargeAdult X-LGPLAYERS NAME: _______________________________________GRADE: ________ PARENTS NAME: _____________________________________________ ADDRESS: __________________________CITY___________ ZIP________ HOME PHONE: ____________________ CELL PHONE: MOM ( ) _____________________DAD ( ) __________________573405012954000PLAYER’S AGE: ________ BIRTHDAY: ______________ EMAIL: ______________________________________________________ WAIVER FORM Parent Permission and Authorization for Treatment: We hereby give our consent for this volleyball player to participate in the above volleyball CAMP. In case of accident or injury, we hereby agree to hold the KC Jaguars Youth Org Inc-Lady Jags VBC, it’s employees, agents, representatives, coaches and volunteers harmless from any and all liability, actions, causes of action, debts, claims, or demands of every kind and nature whatsoever which arises by or in connection with participation by my child in any activities related to this sport. If we cannot be reached and in the event of an emergency, we also give consent for the CAMP director, or its coaches to obtain through a physician or a hospital of its choice, such medical care as is reasonably necessary for the welfare of the player. SIGNATURE OF PARENT/GUARDIAN____________________________ DATE: ______DATE RECEIVED:_______________AMT$_________CHK_______CASH____CHARGE____MAKE PAYABLE TO: KC JAGUARSNO REFUNDS WILL BE GIVEN-419100264795CREDIT CARDS: ___VISA _ __MASTERCARD ___DISCOVER ___AMERICAN EXPRESS _____TOTAL AMOUNTCREDIT CARD NUMBER: VERIFICATION CODE *LAST 3 DIGITS ON REVERSE SIDE OF CARDNAME (AS APPEARS ON CARD) ___________________________________________BILLING ADDRESS____________________________CITY______________ST____ ZIP________SIGNATURE __________________________________ EXPIRATION DATE ___ ___/ ___ ____Month / Year020000CREDIT CARDS: ___VISA _ __MASTERCARD ___DISCOVER ___AMERICAN EXPRESS _____TOTAL AMOUNTCREDIT CARD NUMBER: VERIFICATION CODE *LAST 3 DIGITS ON REVERSE SIDE OF CARDNAME (AS APPEARS ON CARD) ___________________________________________BILLING ADDRESS____________________________CITY______________ST____ ZIP________SIGNATURE __________________________________ EXPIRATION DATE ___ ___/ ___ ____Month / Year(A $40 SERVICE CHARGE ON ALL RETURNED CHECKS)-7620001460500MAIL COMPLETED FORMS AND PAYMENTS TO: KC JAGS @ 10612 BELLEFONTAINE AVE KCMO 64137 ................
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