Please type or print legibly:
 

NAME:_________________________________ NAME YOU PREFER:_______________________
     last            first        M.I. 


SEX:   M   F    BIRTHDATE(mon/day/year):______________________________________

MAILING ADDRESS:______________________________________________________________
                # & street               apt.#        city,  state     zip
 

HOME PHONE #:________________________  OTHER PHONE #:_________________________

Emergency Contact Name:_________________ Relation:__________ Phone:___________

T-SHIRT SIZE (based on men's sizes):  S   M   L   XL   SPECIAL:_______________

HIGH SCHOOL:___________________________________ YEAR GRADUATED:_______________

CAMPUS ATTENDING IN FALL 1996:

     _____ UH Manoa     _____ Community College: Campus_______________

     _____ Other: Campus:_____________________________________________
 

INTENDED MAJOR:__________________________   If undecided, check here:_________

Any Medical Requirements or Restrictions? ____________________________________

How did you find out about Frosh Camp?  circle all that apply

   Flyer/Poster   School Visitation   Friend   Called for application
 
     Other:_____________________________


PHOTOGRAPH RELEASE


If a photograph of this participant is taken while he/she is participating
in a YMCA activity, I authorize the YMCA to display or publish any such
photograph but without identifying the camper by name, in any report of 
promotional material by the YMCA concerning its program activities.

 
_____ Yes _____ No, I would not like such photographs displayed or
                    published.  
 

_____________________________________________________    _____________________
Signature of Parent/legal Guardian (if under 18)               Date
 (You may sign release yourself if 18 and over) 

         If my son/daughter requires care, in the judgment of the
         YMCA staff, or volunteer leader, I authorize and instruct
         the YMCA to infor the Emergency Contact Person and/or
         Physician stated on the attached sheet:


My son's/daughter's name:_____________________________________________________

Insured under:________________________________________________(Name on policy)

Medical Insurer:__________________________________________(HMSA, Kaiser, etc.)

Card or Policy number:________________________________________________________ 

         If neither the Emergency contact Person nor the Physician
         can be promptly reached, I authorize the YMCA to take my
         son/daughter to the nearest hospital or clinic, for such
         medical care.


_______________________________________________   ____________________________
        Signature or Parent or Guardian                       Date