Please print clearly.

Name   ______________________________________________________________             Age ________________      

T-Shirt Size _______________________________________                                                                        

Address ______________________________________________________________________________________



City __________________________________________         State _____________            Zip ___________________


E-Mail Address __________________________________________________________________


Parent/Guardian Name & Number ____________________________________________________

Home# _______________________   Cell# ___________ ________________        
                                                                          

Emergency Contact Name & Number (if different from above)


_______________________________________________________________

Thanks to all of the parents/guardians who thave encouraged their kids to attend the camp. You are more than welcome to attend the camp as spectators and to cheer the kids on.


Please print this page and mail or fax the information, along with the Insurance and Medical info to SERA, Attn:  S. Nigel Platt, PO Box 14790, Greenville SC 29610, fax number 864-246-4425.  To pay by credit card click on the link to PayPal below or checks are to made payable to SERA, LLC and sent to PO Box 14790, Greenville SC 29610.