Kobe Academy - Attendee Information

1. Attendee Information

First Name:
Last Name:
Date of Birth:
Email:
Gender:

Male

Female

Height / ie. 5'8:
Weight (pounds):
Comments:
(Existing Allergies or Medication)
(Roommate Request if registering for Night Camp)

2. Parent/Guardian Information

First Name:
Last Name:
Email:
Phone Number:
Address:
City:

State:

Zip:

I Agree to the Terms and Conditions
I certify that the foregoing statements are true and complete to the best
of my knowledge and belief, and understand that any willfully false
statements is sufficient cause for my application to be rejected.

I Agree to the Medical Liability & Appearance Releases / Click Here to View
I certify that by checking this box I have read and hereby agree to both the Medical and Appearance release.