Kickball Club Registration

Fee: $70 (includes t-shirt)

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Student Name *

First

Last

Grade *

Parent Name *

First

Last

Parent Email *

Parent Phone *

Emergency Contact Number *

Student Shirt Size *

Additional Information

Permission and Acknowledgement: *

By checking this box I acknowledge that all information provided to Summit Academy on the Student and Family information form including medical information, emergency contact, and pick-up authorization, is accurate and up-to-date. All permissions given to Summit Academy staff through my checking the box on the Student and Family Information form also pertain to Clubs and After School Activities staff.