Jun4 Register for Summer Workouts Please enable JavaScript in your browser to complete this form.Camper Information - Step 1 of 4Name of Camper *FirstLastName of Parent / Guardian *FirstLastGrade (2020-21 School Year) *8th Grade9th Grade10th Grade11th Grade12th GradeSchool *Central Middle SchoolMadison Middle SchoolBartlesville High SchoolNot ListedEnter School NameHome Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *NextDisclaimer / Policy Statement *I have read and understand the Disclaimer / Policy statement below *I, the undersigned, being the individual, spouse, or legally authorized and qualified guardian of the student named, agree to hold Bartlesville Public Schools, it's Board of Trustees, administration, and/or faculty, harmless from all liability for any injuries which my son/daughter may receive while participating in recreational activities or utilizing the Bartlesville School District facilities. I hereby authorize the athletic director, coach and/or district employee to secure medical services for any family memberif necessary, and I agree to pay either directly or through my own personal health and accident insurance policy all medical costsEnter First and Last Name as Signature for acceptance of Dislaimer / Policy Statement *Date of acceptance for Disclaimer / Policy Statement *Street Address of Signing Parent / GuardianAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNextParent / Guardian Name *FirstLastFather's Place of EmploymentMother's Place of EmploymentFamily Physician *Family Physician Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeInsurance CompanyInsurance Policy NumberNextCamp to be attended *10th - 12th BoysPlease note that you will be assigned a time due to Social Distancing Guidelines. 10th-12th graders will be between 8am-10am. 8th/9th graders will be between 10am-11amType of PaymentCheck or CashCredit Card via Paypal Mail or Drop off: Coach Jason Sport 1700 Hillcrest Drive Bartlesville, Ok 74006 PayPal screen will prompt after select SUBMIT EmailSubmit