Name of athlete:

Address:

City: State:  Zip Code:

 Home Phone:  

Emergency Phone Number (s)

Email Address:

Parent/Guardian Name:

What grade is the athlete entering?

Under Armour Camp Shirt $15 this is a discounted price and CANNOT be ordered the time of camp. PLEASE SELECT BELOW

NOT INTERESTED YOUTH BOYS LARGE ADULT MENS SMALL ADULT MENS MEDIUM ADULT MENS LARGE ADULT MENS XLARGE GIRLS V NECK YOUTH LARGE WOMENS V NECK ADULT SMALL WOMENS V NECK ADULT MEDIUM WOMENS V NECK ADULT LARGE

What sport (s) does the athlete play?

How did you hear about ASA?

Which camp are you registering for?

  Location MSJ -July 11th Grades 6-12

Waiver and Release

I/We the undersigned, or ourselves, our heirs, executors and Administrators, waiver and release and forever discharge Mt. St. Joseph High School, Carroll Indoor and Achieve Speed Academy, its staff, officers, agents, representatives,  employees, successors and assigns of and from any and all rights and claims for damages to personal property which may be sustained or occurred during participation in camp activities, or from camp, whether paid damages, injuries or loss are negligence or not.  Client will save and hold harmless Achieve Speed Academy, Inc, its officers and representatives from any liability whatsoever with respect to injuries that may occur while under the directions and training of client. I/We also give permission to have the applicant video taped and be used by the Achieve Speed Academy Staff for promotion.

I certify that the applicant is in good physical condition to take part in the Achieve Speed Academy.

I certify that I am the legal Parent/Guardian of the applicant ---Agree --- Disagree

The above Waiver and Release I -- Agree  --  Disagree