Form

BOND SHYMANSKY VOLLEYBALL CAMP
Camper First Name *
Camper Last Name *
Date of Birth *
Address *
City *
State *
Zip *
Parent/Guardian *
E-mail (used for confirmation) *
Home Phone *
Work/Cell Phone *
School *
Grade (Fall '09) *
Years Experience *
Position *
Coach's Name (Team Campers Only)
Coach's Email (Team Campers Only)
T-Shirt Size
Roommate Request (Overnight Camp Only)
Allergies to Medication *
Known Medical Conditions *
Emergency Contact *
Relationship
Daytime Phone *
Evening Phone *
Insurance Company *
Policy Number *
Insurance Phone
I hereby authorize any medical treatment, which may be advised or recommended by the camp trainers or attending physician while attending the Bond Shymansky Volleyball Camp. I understand that an injury may result from participation in camp related activities. I hereby release Bond Shymansky Volleyball Camp, the coaching staff and trainers, the Georgia Tech Athletics Association and the Georgia Institute of Technology from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by my child while participating in such camprelated activities, or while it, or, or upon the premises where the activity is being conducted. As the parent or guardian of the above listed camper, I also give permission for any emergency medical care that may be required, including transportation and I accept responsibility for the costs.
I agree to the terms above *	Yes
Select Camp(s):	Advanced Camp I ($195) Advanced Camp II ($195) Elite Camp - Day ($255) Elite Camp - Overnight ($355) Team Camp - Day ($255) Team Camp - Overnight ($295) Test ($1) Total : $0