Summer 2010 Program Application

Participant Name:
,
Participant Age:

Address:
City: State: Zip:

Phone Number: ( ) -
Email Address:

Parent / Guardian Name:
,

Returning Participant
Yes No

Can we use participant's photo for program promotion
Yes No

Site Preference: (Only list sites you are willing to go to)
1)
2)
3)
4)

Registration: Individual - $30 Family - $50

Payment Method: Mail in check Credit card online

I have read and agree to the terms of the "Release and Waiver of Liability"