indian hill summer athletic camps registration/waiver camp name...

Indian Hill Summer Athletic Camps REGISTRATION/WAIVER

Camp Name ______________________________________________

Name of Camper __________________________________________

Age _________ Grade in Fall 2015 _______________

Parent/Guardian Name ______________________________________

Address ____________________________________________________

Zip __________________ Home # _____________________________

Work # ________________________Cell # ________________________

E-mail _____________________________________________________

T Shirt Size Circle One

Youth S M L XL

Adult S M L XL

I, the undersigned parent/guardian of the individual named above, understandthat this activity involves an element of risk and a danger of accidents and Injury and knowing those risks I hereby assume those risks. I authorize the program directors and/or instructors as Agents for the undersigned to consentto medical, surgical and/or dental examination, in addition to any and allother treatments that may be deemed necessary by medical personnel. Inaddition, I understand that by signing this agreement, I hereby knowingly release and discharge Indian Hill Exempted Village School District from anyand all liability resulting from any injury associated with the above named individual's participation in this activity. Indian Hill Exempted Village Schoolswill not provide health and/or accident insurance for program participants.By signing below, I attest that I have read and fully understand and agree to the assumption of risk, waiver and release of all claims set forth herein.

Parent/Guardian Print Name _________________________________________

Sign Name __________________________________________

PLEASE RETURN THIS COMPETED FORM ANDSEPERATE CHECK FOR EACH CAMP MADE PAYABLE TO:

Indian Hill Athletic Department 6855 Drake Rd.

Cincinnati, OH 45243

Volleyball – IH High School GymDate: June 1 – June 4Grades: 4 – 8Time: 3 – 6 pmCost: $100/camperContact: Coach Ellen Hughes ellen.hughes@ih.k12.oh.us

Girls Soccer – Shawnee Soccer StadiumDate: June 1 - 4Grades: 4 – 8Time: 5 – 7:30pmCost: $100/camperContact: Coach Amy Dunlap amy.dunlap@ih.k12.oh.us

Boys Basketball – IH High School GymDate: June 1 – June 4Grades 3 – 5

• 9 – 11:30amGrades:: 6 – 8

• 12:00 – 2:30 pmCost: $100 / camperContact: Coach Tim Burch tburch228@yahoo.com

Girls Basketball – IH High School GymDate: June 15 – June 17Grades: 3 – 6

• 9 – 12 pmGrades: 7 – 12

• 1 – 4 pmCost: $75/camperContact: Coach Chris Arington r.smith@prasco.com

Football – Tomahawk StadiumDate: June 3 - 5Grades: 1 – 5

• 9:00 – 10:30pmGrades: 6 – 8

• 10:45 – 12:15pmCost: $75/camperContact: Coach Tony Arcuri tony.arcuri@ih.k12.oh.us

Cheerleading - IH Middle School GymDate: Aug 3 – Aug 7Grades: 1 – 8Time: 9 – 12 pmCost: $100/camperContact: Coach Kristen Bratcherkristenbratch@gmail.com

Baseball – IH Baseball FieldDates: June 15 – June 17Grades: 3 - 6

• 9 – 11:00amGrades: 7 – 8

• 12:00 – 2:00pmCost: $75.00Contact: Coach Scott Lloydslloyd@luxotticaretail.com

GENERAL INFORMATION

Indian Hill Athletic Department is sponsoring Summer Camps across a variety of sports and

ages.

All interested campers should fill out the waiver and

registration form attached and mail back with payment to:

Indian Hill Athletic Department

6855 Drake Rd.Cincinnati, OH 45243

Payment can also be made via EZ Pay -

https://www.spsezpay.com

Please contact the Indian Hill Athletic Department

513-272-4631

Please make separate checks for all camps.

Indian Hill Braves

2015Indian Hill

Summer Sports Camps

6855 Drake Road.Cincinnati, OH

45243513-272-4631