Intercollegiate Field Hockey Camps
Application

PLEASE COMPLETE, PRINT, SIGN, AND MAIL WITH DEPOSIT

Registration deposit of $290 must accompany all applications. The balance is due June 1st. If WITHDRAWAL is necessary, written notification must be received by July 10th for refund, less $60 processing fee. NO REFUNDS AFTER JULY 10th. INSUFFICIENT FUNDS FEE is $35. Make check payable to: Intercollegiate Field Hockey Camps, Inc.
Name: Parent's Name:
Address: City: State: ZIP:
Home Phone : Emergency Phone :
School Name: Position you play:
Coach's Name : Coach's Phone :
Coach email: Roommate Request :
(One only)
Grade Entering in Fall: Age at Camp: Birth Date:
     

Parent's Authorization: In consideration for allowing my daughter to participate in this camp, I hereby: 1. Agree that to the best of my knowledge the medical information is correct and complete; 2. Agree to assume all risk of personal injury arising from my daughter's participation, understanding that field hockey inherently involves risk; 3. Agree not to hold responsible, or institute action against I.F.H.C. for any personal injuries sustained while my daughter participates at camp; and 4. Authorize IF.H.C. to act on my daughter's behalf and to obtain medical care, at my expense, that is deemed necessary in the camp director's best judgment.

*MUST BE COMPLETED - FORM WILL BE RETURNED IF NOT COMPLETED.
*Parent or Guardian Signature ___________________________________________________ Date: ________________
*Health Insurance Co.: ___________________________________*Health Insurance Group/ID Code: ____________________
  


List all Vaccinations player has had:_____________________________________________________________________________


Please explain any current medical problems/medications (if any):

_______________________________________________________________________________________________________________

________________________________________________________________________________________________________________

Please attach any further explanation of medical problems to application.

  
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Intercollegiate Field Hockey Camps, Inc.
P.O. Box 6037, Lawrenceville, NJ 08648 Phone : 609-895-2104 – Fax : 609-844-1232

Email us at mailto:[email protected]

Copyright © 2002 Intercollegiate Field Hockey Camps, Inc. - All Rights Reserved

 

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