Registration Form
Print, complete and mail this form to the address below.
Street:_________________________________________________________
City:______________________________ State: _________ Zip: _________
Age: _______________________
Home Phone: _________________________________
Work Phone: _________________________________
Cell Phone: ___________________________________
Email Address: ________________________________
Tee Shirt Size (Adult Sizes--circle one)
Small Medium Large X-Large
Please enroll the above. I understand that neither the Lincoln Sports Camps nor anyone assoiciated with the camp will assume responsibility for accidents and medical and dental expenses incurred as a result of participation in the program. The applicant is in good health and able to participate in the physical activity of this camp. In the event of an injury or sickness, the camp has my permission to provide medical care.
Parent Signature: ______________________________________________
Make checks payable to: Lincoln Sports Camps
Mail to: Jon Bruckner
PO Box 501
Lincoln, RI 02865