REGISTRATION FORM 2008 Summer Speed & Agility Camp

Name:______________________________________________ Age:_____

Sport(s):___________________________________________________________________

Address:_________________________________________________________________________

Phone #:___________________________

Emergency Contact:_______________________________________________

Phone #:___________________________

T-Shirt Size: adult S/M/L/XL/XXL (Please circle one size)

Parental Consent:________________________________________________
(necessary if under the age of 18) (Signature)

Please return Registration Form to: GO SPORT PHYSICAL THERAPY
c/o Speed and Agility
16C Deatrick Drive
Gettysburg, PA 17325

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