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, und that this activity involves an element of risk and a danger of accide Injury and knowing those risks I hereby assume those risks. I author program directors and/or instructors as Agents for the undersigned to to medical, surgical and/or dental examination, in addition to any an other treatments that may be deemed necessary by medical personnel. addition, I understand that by signing this agreement, I hereby knowi release and discharge Indian Hill Exempted Village School District fr and all liability resulting from any injury associated with the above individual's participation in this activity. Indian Hill Exempted Vi will not provide health and/or accident insurance for program partici By signing below, I attest that I have read and fully understand and the assumption of risk, waiver and release of all claims set forth he Parent/Guardian Print Name _________________________________________ Sign Name __________________________________________ PLEASE RETURN THIS COMPETED FORM AND SEPERATE CHECK FOR EACH CAMP MADE PAYABLE TO: Indian Hill Athletic Department 6855 Drake Rd. Cincinnati, OH 45243 Volleyball – IH High School Gym Date: June 1 – June 4 Grades: 4 – 8 Time: 3 – 6 pm Cost: $100/camper Contact: Coach Ellen Hughes [email protected] Girls Soccer – Shawnee Soccer Stadium Date: June 1 - 4 Grades: 4 – 8 Time: 5 – 7:30pm Cost: $100/camper Contact: Coach Amy Dunlap [email protected] Boys Basketball – IH High School Gym Date: June 1 – June 4 Grades 3 – 5 • 9 – 11:30am Grades:: 6 – 8 • 12:00 – 2:30 pm Cost: $100 / camper Contact: Coach Tim Burch [email protected] Girls Basketball – IH High School Gym Date: June 15 – June 17 Grades: 3 – 6 • 9 – 12 pm Grades: 7 – 12 • 1 – 4 pm Cost: $75/camper Contact: Coach Chris Arington [email protected] Football – Tomahawk Stadium Date: June 3 - 5 Grades: 1 – 5 • 9:00 – 10:30pm Grades: 6 – 8 • 10:45 – 12:15pm Cost: $75/camper Contact: Coach Tony Arcuri [email protected] Cheerleading - IH Middle School Gym Date: Aug 3 – Aug 7 Grades: 1 – 8 Time: 9 – 12 pm Cost: $100/camper Contact: Coach Kristen Bratcher [email protected] Baseball – IH Baseball Field Dates: June 15 – June 17 Grades: 3 - 6 • 9 – 11:00am Grades: 7 – 8 • 12:00 – 2:00pm Cost: $75.00 Contact: Coach Scott Lloyd [email protected]

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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 [email protected]

Girls Soccer – Shawnee Soccer StadiumDate: June 1 - 4Grades: 4 – 8Time: 5 – 7:30pmCost: $100/camperContact: Coach Amy Dunlap [email protected]

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 [email protected]

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

• 9 – 12 pmGrades: 7 – 12