Kenrick Sealy

Application Form

Fifth Annual

Coach Sealy�s

Silver Bullets Summer Track Camp

Kenrick Sealy

2750 Joseph Ave. Apt # 9

Campbell, CA 95008

Tel. (408) 626-8651

The following is the official entry form for the 2004 Coach Sealy�s Silver Bullets Summer Track Camp scheduled to begin on May 27^th at Homestead High School. Please fill out and sign the necessary information that is applicable to you. Make checks payable to Kenrick Sealy.

Name (s): ------------------------------------------------------------------------------------------------------------------

Parents ---------------------------------------------------------------------------------------------------------------------

Address: -------------------------------------------------------------------------------------------------------------------

Email address: ----------------------------------------------------------------------------------------------------------

School/Grade: -----------------------------------------------------------------------------------------------------------

Telephone: (H) ---------------------------------- (cell) --------------------------------

Fees: Check one Individual $ 110.00 ( ) or Family $150.00 ( )

I, the undersigned, totally agreed to participate in the aforementioned program with the knowledge that I am capable, fit and healthy to perform the task (s) that is/are asked of me during the length of the camp. I totally understand the terms and agreement of this contract and have all plans on executing them.

Signature -------------------------------------------------------------- Date: -----------------------------------------------