EXSP WEST - Athlete Assessment Registration

Athletes Name:
Team Name:
Age:
DOB (mm/dd/yy):
Address:
Parent(s) / Legal Guardian Name:
Home Phone:
-
Cell Phone:
-
Parents E-mail:
Emergency Contact:
Emergency Contact Phone:
-

Select Date & Time:

Please note this assessment will be held at our EXSP WEST LOCATION:  3608 Hartzdale Drive, Camp Hill, PA

After completing this form, you will be redirected to our Release of Liability Form. Please print and sign, and bring in with your child on the first day of camp. Thank you!