Fall Break Camp Name* First Last Age* Grade* Address* Street Address City ZIP Code Mother's Cell #*Father's Cell #*Email Address* Best Contact Number*Permission (Parents Signature)* ______________has my permission to participate in the SCORE camp, I, as the undersigned, here by release and hold harmless the coaches, SCORE, and any associated sponsors from any and all claims and liability for personal injury arising from participate in all activites and authorize any neccessary medical, diagnostic/hospital procedure as may be performed or prescirbed by a licensed physician. I understand by submitting this form I am authorizing the minor to participate in the SCORE program.DateMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parents Name First Last Physicians Name First Last Physicians PhoneUntitledHow will you be paying?CashOnlineSpecial Needs Camp: No payment requiredTo Complete Registration Please Indicate if you are paying with cash or online. If paying online proceed to step 2 of the registration process at scorebball.com **Remember**As of August 1, 2013 we will no longer be accepting checks.