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Name ________________________
Address ____________________________
City _____________
Zip
Phone( __ ) ___________________
e-mail _________________________________
I will be entering
grade at _________________________
in the fall of 2007
T-shirt size (Adult sizes, Please Circle One)
S M L
XL XXL
Cost: $45 for all registrations in the school
office by May 25th.
$55 for registrations received after the 23rd.
Make checks payable to
Lutheran High Northwest
1000 Bagley
Rochester Hills, MI. 48309
(248) 852-6677
Questions, Contact:
Don Justice - Athletic Director
Gisela Baldwin - Athletic Secretary
I hereby authorize the
directors of LHNW
Volleyball Camp
to act for me according to their
best judgement,
in any emergency requiring
medical attention;
and I hereby release,
exonerate, and discharge
LHNW Volleyball
Camp and its employees from any action,
known or unknown,
for any injuries while at LHNW Volleyball Camp.
Parent or Guardian Signature
(Required):
Insurance:
Group No.
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