OPS / FAZZOLARI SPEED CAMP REGISTRATION FORM

This form must be sent to OhioPrepScene.com for the July 2004 Speed Camp / Combine.

OPS - FAZZOLARI FITNESS SPEED CAMP REGISTRATION FORM

PARENTS NAME:___________________________________________

ATHLETE NAME:___________________________________________

ADDRESS:_________________________________________________

CITY:__________________ STATE:____________ ZIP:______________

PHONE # (_____) - _________ - __________ E-Mail:______________________________

CURRENT GRADE:______________ DATE OF BIRTH:________________

AGE:______SCHOOL:_____________________SPORT PLAYED:___________________

CHECK ONE: BOY:_________ GIRL:_________

SHIRT SIZE: SM_____M_____L______XL_____XXL_____XXXL_____

RELEASE FORM & PAYMENT WILL NOT BE ACCEPTED DAY OF CAMP

I hereby release OhioPrepScene.com / Fazzolari Fitness and its officers from all claims on account of pre-existing injury, pre-existing medical condition or any injuries sustained at the OhioPrepScene.com / Fazzolari Fitness Speed Camp. I agree to indemnify OhioPrepScene.com & Fazzolari Fitness and its officials of any claims, which may here after results from such injuries. I hereby state that my son/daughter is physically fit to participate in the OhioPrepScene.com / Fazzolari Fitness Speed Camp.

Parents Signature:_________________________________________

Date:________________

Do you agree to the Waiver Form? YES______NO________ to attend you must agree to waiver.

Medical Problems:_________________________________________________

Allergies:_________________________________________________________

I certify that the above information and statements, both personal & medical are true and that my athlete is in good health and able to participate in the OhioPrepScene.com / Fazzolari Speed Camp.

Parents Signature:______________________________ Date:__________________

I have made $50.00 payment with Check# ___________ All campers must pre-register. No registrations will be accepted at the day of the camp.

Make $50.00 check payable to Ohio Prep Scene and mail form to the following

Ohio Prep Scene

1312 CampHill Way #1

West Carrollton, Ohio 45449

If you have any questions, please e-mail them to the following: [e-mail] ATT: Speed Camp. This form must be completed and returned to OhioPrepScene.com. There are no refunds given if unable to attend, or registrations accepted at the camp.