PICO Camp and Clinics Registration:

All fields (except comments) must be completed for the form to work.

Player's Name
Age	Current Grade
T-Shirt Size	Small Medium Large X Large XXLarge No Shirt
School
	Check if registered in Beaverton HS football program
Parents Name
Address
City, State, Zip
Daytime Phone
Home Phone
E-Mail
In case of emergency, please contact:
Name
Contact Phone
Relationship to child
Additional Comments (optional)
	We like to take pictures! If you do not want your child photographed for our website and future promotional materials, please check the box.
Help Us Grow! Please let us know how you heard of us (optional):

This is to certify that the above-named child has had a physical examination by a licensed physician within the last six (6) months and is free from any illnesses, injuries, or conditions which could inhibit the child from activities of the camp. I will notify coaches prior to the camp or clinic of any physical conditions that may inhibit play.

I hereby release the Pacific Islander Coaches of Oregon, its staff and sponsors from any and all liability (present and/or future) for injuries that may be incurred by my child while participating in camp activities. (A "NO" reply will not allow your child to participate.)
Yes No

X
(Please type name to serve as signature of parent or guardian)

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NOTE: Camp fees will not be refunded or pro-rated.

Please print this form for your records before you hit "Continue to Payment."