Camper Name *

First Name

Last Name

*

Male

Female

Phone *

(###)

###

####

Waiver and Release: *

By checking this box, I understand and agree to the following: as one of the conditions of my child's participation, specifically release TeamGRE3N, its coaches, trainers, and volunteers (including LeMoyne Owen College and Paradigm Dental Center) from any claims or liabilities of any kind whatsoever, arising from or related to my child's participation in these activities. I agree to grant to TeamGRE3N and its authorized representatives permission to record on photography film and/or video, pictures of my child's participation. I further agree that any or all of the material photographed may be used, in any form, as part of any future publications, brochure, or other printed materials used to promote TeamGRE3N.