Application for 2011 Softball Profiles Camp at CNU June 21-23rd, 2011

with Optional pitcher/catcher session June 20th

Make Checks Payable to: Softball Profiles

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

$150 non-refundable deposit holds spot, balance is due by June 1, 2011

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 _____________

Optional Pitcher/Catcher Camp Mon-Thurs ($615.00) Postmarked June 1, 2011, $635 thereafter

Overnight Camper Tues-Thurs ($515.00) Postmarked June 1, 2011, $535 thereafter

Team Rate ($470.00 each for team of 8) by June 1st, 2011, $490 thereafter,; pitcher/catcher add $100

Day Camper ($470.00) by June 1, 2011, $490 thereafter; pitcher/catcher add $100