Registration - WUVB Skills Camp - August 4, 2025

Student Name: Student Name: First Last
Date of Birth: Date of Birth: / MM / DD YYYY
Student Phone Number Student Phone Number - ### - ### ####
Student Email
Parent/Guardian Email:
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
High School
High School Graduation Year
Head Coach Head Coach First Last
Emergency Contact #1 Emergency Contact #1 First Last
Relationship
Phone Number 1 Phone Number 1 - ### - ### ####
Emergency Contact #2 Emergency Contact #2 First Last
Relationship
Phone Number 2 Phone Number 2 - ### - ### ####
Insurance Company
Policy Holder Name
Policy Number
Please list any food allergies: