Application and Waiver and Release may be printed, completed and mailed (with your deposit) to:  Angela Martin Jumps Camp, Indiana State University, Arena 111, Terre Haute, IN 47809.

Name:____________________________________________________________________
                   Last                                       First                  Middle Initial
Address___________________________________________________________________

City___________________________________State__________Zip__________________

Age at Camp______ Grade (Next Year)_______ Men's Size T-Shirt      S      M    L     XL

Height__________________  Weight_________________

Parent's Name_____________________________________ Phone (____)_____________

Parent/guardian signature_____________________________________________________

Varsity Coach______________________________ School__________________________

High Jump Personal Best ___ ft. ____ in.    Roommate Preference___________________

In case of an emergency contact me at (phone number)

Work_______________________________________

Home______________________________________
 

Amount Enclosed     Deposit $_____________    Full Amount $_______________
 

Release for Medical Treatment (Pre-Registration WILL NOT be complete until this signed form is returned.)

NAME OF CAMPER______________________________________________________

In consideration of my child's application being accepted, I intending to be legally bound, do hereby, for myself, my heirs, executors and administrators, waive, release and forever discharge any and all rights and claims for damages, which my child may have or which may hereafter accrue to them against the Angela Martin High Jump Camp, or its or their respective officers, agents, representatives, successors and/or assigns; for any and all damages which may be sustained or suffered by them in conjunction with their association with or participation in and/or rising out of their traveling to or returning from the Angela Martin High Jump Camp to be participated in on the campus of Indiana State University, Terre Haute, Indiana.

Signature (Parent/Guardian)_________________________________ Date____________