2025 GRINDHOUSE SUMMER HELL CAMP

Step 1 of 3: Submit

Participant First Name Participant Last Name Street Address City, State, Zip Participant Age (Please Select Appropriate Age For Camp) Participant Grade (Please Select Appropriate Grade Level For Camp) Participant School T-Shirt Size

Parent/Guardian First Name Parent/Guardian Last Name Parent/Guardian Phone Number Parent/Guardian Email

Emergency Contact First Name Emergency Contact Last Name Emergency Contact Phone Number

Does Participant Have Any Allergies We Need To Be Aware Of? YES NO

If Yes, Please List Allergies

Does Participant Have Any Other Medical Conditions We Need To Be Aware Of? YES NO

If Yes, Please List Medical Conditions Medical Insurance Company Medical Insurance Policy Holder Medical Insurance Phone Number Medical Insurance Policy Number Medical Insurance Group Number Hospital of Choice

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I have read Waiver of Liability and acknowledge

Registration Payment

Registration Fee