*Email Address

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*Parent/Guardian first name:

*Parent/Guardian last name:

*Parent Phone # (house)

*Parent Phone # (cell)

*Street Address

*City:

*Postal Code:

*Player's Year of Birth

*Player's First Name:

*Player's Last Name:

Sex of Player

Male

Female

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*Player's Date of Birth:

(month/day/year)

*Players Shirt Size:

youth - small youth - medium youth - large youth - X large adult - small adult - medium adult - large adult - X large

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Week 1 (July 8 - 12)

Junior Camp (born 2009-2012)

Intermediate Camp (born 2006-2008)

Senior Camp (born 2001-2005)

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Week 2 (July 15 - 19)

Junior Camp (born 2009-2012)

Intermediate Camp (born 2006-2008)

Senior Camp (born 2001-2005)

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Week 3 (July 22 - July 26)

Junior Camp (born 2009-2012)

Intermediate Camp (born 2006-2008)

Senior Camp (born 2001-2005)

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Specialty Camps

Viper Jr. Boys Elite Development Camp (born 2006-2009 (requires approval)

Viper Jr. Girls Elite Development Camp Born 2006-2009 (requires approval)

Viper Sr. Boys Elite Development Camp (born 2001-2005) (requires approval)

Viper Sr. Girls Elite Development Camp (born 2001-2005) (requires approval)

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Shooting Camp AM (born 2006-2009) (9:00 a.m. to 12:00 noon)

Shooting Camp PM (born 2001-2005) (12:30 a.m. to 3:30 noon)

Check one Viper Camp/Check one Shooting Camp

Viper Camp Approval

This player played on a KW Viper rep team in 2018-19

This player did not play on a KW Viper rep team in 2018-19. Approval has been given by the following coach:

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Approval Coach:

*Waiver of Liability

ATTENTION: Please read the following very carefully before signing as it affects your legal rights. If the participant is under 18 years of age the following must be reviewed and approved by a parent/guardian. 1. That participating in this program may involve personal risk of damage or injury and Iagree to assume all such risk and hereby release the KW YBA and its employees and agents from all claims for damage or injury to my child that might result from his/her participation in the program save and except those damages and injuries caused solely by the negligence of the KW YBA, its employees, volunteers or agents. 2. That I will be solely responsible for making arrangements for the picking up of my child and will advise the KW YBA in writing if I have any concerns or there needs to be any special needs or arrangements. 3. That violation of the KW YBA’s Code of Conduct by my child my result in temporary or permanent banning from the program at the KW YBA’s discretion. By clicking on the check box, I acknowledge having read, understood and agreed to the above conditions, release and waiver.

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