Application for 2008 Campers

Make Checks Payable to: Softball Profiles

Print a Copy and Mail To:
P.O. Box 2924
Leesburg, VA 20177

Medical Insurance Coverage (Required)

*Note: Parents/Guardian Signatures needed below.

*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 _____________

Overnight Camper ($535.00) Postmarked June 1, 2008

Late Registration ($555.00) Postmarked June 2, 2008 or later

Day Camper ($475.00)

See Special instructions attached.