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Registration Form
AFTER SUBMITTING THIS FORM, PLEASE SEND CHECK PAYABLE TO DELTA BLADES JUNIOR CREW TO:
1833 W. March Lane, Suite 3, Stockton, CA 95207
Registration Type
Registration Type
--- Make Selection ---
Mini Clinic
Pre-Team Camp
High Performance Camp
Varsity Team - Fall
Varsity Team - Spring
Winter Rowing Clinic
Applicant Info
Athlete Name
Height
Weight
Age
Birthdate
School
Grade
Other Varsity Sports?
How did you hear about us?
Parent Info
Parent Name (s)
Employer (1)
Employer (2)
Contact Info
Street Address
City
State
Zip Code
Home Phone (Eve)
Parent Day Phone(1)
Parent Day Phone(2)
Althlete Cell Phone
Parent Cell Phone (1)
Parent Cell Phone (2)
Athlete Email
Parent Email 1
Parent Email 2
Medical
Health Insurance Provider
Policy #
Emergency Contact Name
Relationship to Athlete
Emergency Contact Day Phone
Emergency Contact Eve Phone
Pre-Existing Medical Conditions? (including asthma)
Current Medications
Allergies (Food, Medical, etc)
I have read and accept the terms of the Delta Blades policies, waiver, release and informed consent document.
