D2 Paper

Player Information

Name*

First Last

Birthdate*

MM

DD

YYYY

Emergency Contact*

Emergency Phone*

Medical Conditions

Parent Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Class Information

Class/Session/Week

D2.1 (May 25 & 27)
D2.2 (June 1 & 3)
D2.3 (June 8 & 10)
D2.4 (June 15 & 17)
D2.5 (June 29 & July 1)
D2.6 (July 6 & 8)
D2.7 (July 13 & 15)
D2.8 (July 20 & 22)
D2.9 (July 27 & July 29)

Class Fee

Payment Type

Cash
Check
Credit Card

Other Form of Payment

Photo Release

Yes
No

I give permission for my child to be photographed and for those photos to be used, if selected for a range of educational and promotional purposes such as print publications, online publications, presentations, websites, and social media.

Date

Notes