2010 Camp Application - Softball Profiles Camp at CNU June 21-23rd

Application for 2010 Softball Profiles Camp at CNU June 21-23rd

Make Checks Payable to: Softball Profiles

Print a Copy and Mail To:
14244 Ashland Rd, Glen Allen VA 23059

$150 non-refundable deposit holds spot, balance is due by June 1, 2010

Camper Name
Address

City		State
Phone - Cell		Phone - Home
Camper Email
High School, State		Grad. Year
Primary Pos.		Secondary Pos.
Age at Camp		Bat/Throw L or R
Height		Weight
GPA		SAT/ACT Scores
Parents Name
Parent's Email
Parent's Cell
Travel Ball Team		Coach/Phone
Referred By

Medical Insurance Coverage (Required)

*Note: Parents/Guardian Signatures needed below.

Company Name
Policy #
Allergies
Medical Conditions

*Medical Consent Form*

I hereby authorize the physicians, nurse practitioners, physician assistants and staff to examine, interview, test, and if necessary, treat my daughter as they deem advisable and disclose such information to other responsible hospital officials as necessary. Each camper is covered by a $25.00 deductible accident policy which covers a $1,000 maximum.

Parent/Guardian Signature __________________________

Relationship ______________ Date _____________

June 21-23rd, 2010 at CNU

Overnight Camper ($495.00) Postmarked June 1, 2010, $515 thereafter

Team Rate ($450.00 each for team of 9) by June 1st, $465 thereafter

Day Camper ($450.00) by June 1, 2010, $465 thereafter

See Special instructions attached.

Make Checks Payable to: Softball Profiles

Print a Copy and Mail To: 14244 Ashland Rd, Glen Allen VA 23059

$150 non-refundable deposit holds spot, balance is due by June 1, 2010

Medical Insurance Coverage (Required)

*Note: Parents/Guardian Signatures needed below.

Print a Copy and Mail To:
14244 Ashland Rd, Glen Allen VA 23059