Liberty North Swimming Camp
_____Novice Ages 7 – 9 ($30) July 25 – 28 @ Clayview 7:30 – 8:15 AM
(Must be able to complete 25 yards Freestyle)
_____Novice Ages 10 – 12 ($30) July 25 – 28 @ Clayview 8:00 – 8:45 AM
(Must be able to complete 25 yards Freestyle)
_____Competitive Camp Ages 8 – 14 ($45) July 25 – 29 @ Clayview 8:30 – 10:00 AM
(Must be able to complete 100 yards Freestyle)
LIBERTY NORTH Summer Camp Registration Form
Name: ________________________________________________________
Address: ________________________________City: ________________
Home Phone: ______________________ Alt. Phone: ______________
Grade & School for fall 2011: __________/__________________________
Grade School
Parent Name (s): _______________________________________________
Emergency Contacts with Phone Numbers (List 2):
- ______________________________ 2. ______________________________
T-Shirt Size (Circle one):
Youth: S M L XL Adult: S M L XL
(Some camps will not offer Youth sizes – for those camps, any Youth size circled will receive an Adult Small)
Medical Release and Insurance Information
Complete Both Lines
I hereby release Liberty Public Schools, Clayview, the Camp Directors and Coaches from any and all liability for injuries, illness, or loss of property that the named registrant may incur or suffer while attending camp.
*Signature of Parent/Guardian:
________________________________________________Date__________________
*Name of Insurance Company and Policy Number
______________________________________________________________________
(Insurance Company Name) (Policy Number)
**All checks are made out to Liberty North High School
**Register day of camp OR send check and registration form (must be received by July 18th if mailed) to:
Liberty North High School
Athletics Office – Sports Camps
1000 NE 104th Street
Liberty, MO 64068
