Time Out! Boys' and Girls' Recreational Sports Camp

* required information

Camper Information
*First Name:
MI:

*Last Name:
Grade:
Age:
*Gender:
*Street Address:
*City:
*State:
*Zip:
*Home Phone:
Cell Phone:
Parent\Guardian Information
*Parent/Guardian First Name:
*Last Name:
*Phone Number:
*Email Address:

*In Case of Emergency Notify:
*Phone:

Waiver
You must submit a signed waiver to the program before the start of camp. The waiver can be found here. Print, sign, and mail the waiver to:

Kiley Stasch
Assistant Director
Time Out Youth Sports Camp
Goucher College
1021 Dulaney Valley Road
Baltimore, MD 21204

*I agree to submit the waiver:
*Name of Signer:
*Date:
*Relationship to Camper:
*Insurance Company:
*Policy Number:
*Allergies\Medical Conditions: (Enter 'None' if None)

My Child Plans on Attending
Camp Dates: June 23 - 27 - Payment Options
The full balance is to be paid by June 2, 2014. All payments must be made online with a valid credit\debit card.

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