To Register Please fill out the following information (bold fields are mandatory) and click 'Submit'.
For More Info: Call (310) 365-3338

First Name:
Last Name:
Address 1:
Address 2:
City:
State/Province:
Zip Code:
Email Address:
Home Phone:
Cell phone:
School:
Age:
Grade next fall:
Position:
Current medications if any:
Allergies if any:
Physician Name Address And Phone:
Emergency Contact Person name,
address, phone, relationship to the athlete:
students signature:
type your full name
parent signature:
type your full name
todays date
MMDDYY:

With Submission of this form, I authorize SR Skills Positions Academy to use any photo, video image,
or likeness of me/my child for the purpose of Website building, camp advertisement, SR Skills Academy publicity,
or to release upon request to high school, college, and pro coaches when in the best interest of the Student Athlete.
I am/my child is of good health and suffers from no condition that would prevent me/them from participating
in this camp. I authorize SR Skills Positions Academy Staff to seek medical attention and treatment for
myself/my child in the event of a medical emergency.