2022 Brian Wright Youth Camp (K-8)
Online Registration Form
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Email *
First Name *
Last Name *
Grade School *
Parents Name *
Parents Phone Number *
Parents E-mail *
Home Address *
City *
State *
Grade Entering *
Age *
T-Shirt Size *
Insurance Company *
Insurance Policy Number *
By selecting "I agree" I grant permission for my child to participate in the Brian Wright Youth Camp. I attest that my child has not suffered any illnesses in the past that would make participation in the camp a risk. Further, I agree to release from any liability, the Brian Wright Youth Camp, its staff, Pittsburg State University and the Kansas Board of Regents for any injury or illness suffered by my child while attending or traveling to or from this camp. I further authorize the staff of the Brian Wright Youth Camp to act for me in case of any medical emergency because of injury or illness to my child. I acknowledge that I am aware that participation in this camp will require physical activities of a nature which could results in injury to the participants notwithstanding the absence of fault on the part of the camp, its staff, Pittsburg State University and the Kansas Board of Regent. The camp staff has explained to me the particular activities to my satisfaction and I am hereby authorizing my child to participate in these activities. *
A copy of your responses will be emailed to the address you provided.
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