Sports Camp Media Release Form
Please provide participant, guardian, and emergency contact details, then review the media release permission for camp photos and videos.
Participant Information
Participant Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Camp Session or Program Name
*
Parent or Guardian Information
Parent or Guardian Full Name
*
First Name
Middle Name
Last Name
Relationship to Participant
*
Parent
Guardian
Other Caregiver
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact and Media Release
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: