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
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.)

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."




For Payment by Check:

To pay by mail please print out this page or our Printable Registration Form (PDF) and mail it with payment to:

Island Sports and Athletics
2336 SE 24th Ave
Portland, OR 97214

For further information call:
Ace Salu at 503-680-1905

© Pacific Islander Coaches of Oregon
Portland, Oregon
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Kids blocking at 2007 PICO Camp
QB Throwing at 2007 PICO Camp
Basketball - post game
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