Whittier Tech Whittier Tech 2018 Summer Sports Programs 2018 Summer Sports Programs Registration Form Registration Form Please complete and return to: Please complete and return to: Whittier Regional Vocational Technical High School Whittier Regional Vocational Technical High School Attn: Assistant Principal’s O ce Attn: Assistant Principal’s O ce 115 Amesbury Line Road 115 Amesbury Line Road Haverhill, MA 01830 Haverhill, MA 01830 Or register online at: Or register online at: www.whittiertech.org/vacation-camps www.whittiertech.org/vacation-camps Please register by June 30, 2018 Please register by June 30, 2018 Whittier Summer Sports Programs are for students entering grades 6, 7 & 8. Whittier Summer Sports Programs are for students entering grades 6, 7 & 8. Programs run from Monday-Thursday, 8am - 12 noon. Transportation is included. Programs run from Monday-Thursday, 8am - 12 noon. Transportation is included.

Student's Name:______Grade in September 2018______Student's Name:______Grade in September 2018______Address______City/Town/Zip______Address______City/Town/Zip______Male ____ Female Date of Birth______Middle School______Male ____ Female Date of Birth______Middle School______Parent/Guardian Name______Parent/Guardian Name______Home Phone______Cell Phone______Home Phone______Cell Phone______Emergency Contact Name ______Relationship ______Phone ______Emergency Contact Name ______Relationship ______Phone ______Email address ______Email address ______Medical Health Restrictions/Concerns______Medical Health Restrictions/Concerns______$125 per child, per program Total enclosed:______$125 per child, per program Total enclosed:______We accept Mastercard, Visa, Discover or check. Please complete all items below. We accept Mastercard, Visa, Discover or check. Please complete all items below. Account #______CVV#______Expiration Date______Amount Charged______Account #______CVV#______Expiration Date______Amount Charged______Print Name______Signature______Date______Print Name______Signature______Date______

EQUIPMENT, SNACK AND WATER ARE EQUIPMENT, SNACK AND WATER ARE *TO BE PROVIDED BY THE ATHLETE. *TO BE PROVIDED BY THE ATHLETE. *PLEASE INDICATE YOUR SELECTED SPORTS PROGRAM BOY’S LACROSSE: *PLEASE INDICATE YOUR SELECTED SPORTS PROGRAM BOY’S LACROSSE: Bring a helmet, mouth guard, gloves, Bring a helmet, mouth guard, gloves, GIRL’S SOFTBALL JULY 9-12 stick, elbow pads, shoulder pads, cleats GIRL’S SOFTBALL JULY 9-12 stick, elbow pads, shoulder pads, cleats and sneakers. Goalies MUST wear a neck and sneakers. Goalies MUST wear a neck BOY’S LACROSSE JULY 16-19 protector and cup. BOY’S LACROSSE JULY 16-19 protector and cup. BOY’S & GIRL’S BASKETBALL JULY 23-26 GIRL‘S SOFTBALL: BOY’S & GIRL’S BASKETBALL JULY 23-26 GIRL‘S SOFTBALL: Bring a glove, sneakers and cleats. Bring a glove, sneakers and cleats. BOY’S & GIRL’S BASKETBALL JULY 30-AUGUST 2 BOY’S & GIRL’S BASKETBALL: BOY’S & GIRL’S BASKETBALL JULY 30-AUGUST 2 BOY’S & GIRL’S BASKETBALL: Wear sneakers and shorts. Wear sneakers and shorts.

Space is limited - please sign up early. Space is limited - please sign up early. Important - Please read and sign the following: I hereby give my child permission to participate in the activities at Whittier Tech’s Summer Sports Programs. I understand and accept Important - Please read and sign the following: I hereby give my child permission to participate in the activities at Whittier Tech’s Summer Sports Programs. I understand and accept that no one associated with Whittier Regional Vocational Technical High School will be held liable for accidents and/or medical or dental expenses incurred as a result of participation that no one associated with Whittier Regional Vocational Technical High School will be held liable for accidents and/or medical or dental expenses incurred as a result of participation in this program. Participants are responsible for property damage and may be sent home without refund for violation of rules. In the event of illness or injury, the program has my in this program. Participants are responsible for property damage and may be sent home without refund for violation of rules. In the event of illness or injury, the program has my permission to provide emergency medical care. Parent/Guardian signature also serves as a photo release. Images of the Summer Sports Programs activities and participants may be permission to provide emergency medical care. Parent/Guardian signature also serves as a photo release. Images of the Summer Sports Programs activities and participants may be used in the future to promote the program, in print and electronic media. used in the future to promote the program, in print and electronic media.

I intend this statement to take eect as a sealed instrument. I intend this statement to take eect as a sealed instrument. NOTE: Program Coordinator reserves the right to NOTE: Program Coordinator reserves the right to cancel any program that is under-enrolled. cancel any program that is under-enrolled. ______Parent/Guardian Signature Parent/Guardian Signature For more information call 978-373-4101, ext. 254 For more information call 978-373-4101, ext. 254