FILL IN.

MAIL TO: BILL FALK’S CAMPS

                  PO BOX 8102

                  CRANSTON, RI 02920

OR FAX TO: 1-800-682-6950

YOUR CAMP LOCATION CHOICE:___________________

YOUR CAMP EVENT CHOICE:_______________________

IF POLE VAULT: YOUR HEIGHT CLEARED:____________

IF THROWS: YOUR EVENT CHOICE: __________________

NAME_____________________________________________

STREET____________________________________________

CITY, STATE, ZIP ___________________________________

AGE________________

GRADE NEXT FALL_____________

PHONE # ________________

T-SHIRT SIZE (M-XXL ONLY) ____________

IF OVERNIGHT: (RI CAMPS ONLY): YOUR ROOMMATE

CHOICE: ___________________________________________

PAYMENT:

CREDIT CARD # AND EXP _____________________________

OR

CHECK ENCLOSED____________________________________

MANDATORY RELEASE:

    I release Bill Falk Camp and its staff, the

host institution and its staff from any

responsibility for any and all injuries

that occur while participating in the

Bill Falk Camp at the site designated site

Selected by the attendees.

Name ______________________________

is in good physical condition to participate

in the Bill Falk Camp at the designated

location. 

Signature ____________________________

Date ________________________________

(Must be a parent, coach or guardian’s