Home Address _________________________________________________

City ___________________________________ Zip Code ______________

Phone (       ) ______________________ e-mail ______________________

Grade 2005-06 ________________ Height ___________ Weight _________

Parent/Guardian _______________________________________________

Please Mail $50.00 Check (Make Checks Payable to “Focused Shooter”) and Completed Form to:

Focused Shooter, 2701 Harbor Blvd #E-2, Costa Mesa CA  92626

HEALTH AND BEHAVIOR GUIDELINES AND WAIVER OF LIABILITY

HEALTH INSURANCE CO. ______________________________________________________

Policy No. _____________________________________ Group No. _____________________

I understand that any Fullcourt Press OC Spring Showcase (FPOCSS) participant who does not abide by the rules, regulations and policies established by the (FPOCSS) is subject to dismissal without reimbursement or recourse and I hereby waive and release the FPOCSS and El Dorado High School (EDHS) from any and all liability for any injury or illnesses while participating in the camp.  I hereby authorize the directors of the FPOCSS and EDHS to act according to their best judgment in any emergency if I cannot be contacted.  I understand that each camp participant is required to have their own medical and accident insurance.  I also understand that the FPOCSS retains the rights to use for publicity and advertisements purposes, photographs of camp participants.