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Justin Wilcox Football Camps

2227 Piedmont Ave, Berkeley, CA, 94720, US

Form Section 1

2018 Justin Wilcox Youth Football Camp Registration

Participant Contact Information

Participant Name
Date Of Birth
Full Address
Form Section 2

Emergency/Medical Information

Alternate Emergency Contact (Different from Parent/Contact)
Doctor Information
Policy Exp. Date
Policy Holder Name
Form Section 3

Participant Type

Sessions or Days
Day Care 3PM - 5PM
2018 Youth Camp
Session I 400.00
Session II 400.00
A La Carte 100.00
Aftercare Per Day 25.00

Payments processed through Stripe.

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