Application for:

11th annual 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 1st, 2011

Camper Name
T-shirt Size
Primary Position Secondary Pos.
High School, State Grad. Year  20??
Height  ??ft ??in Weight
Bat:  right or left? Throw: right or left
Camper Cell # Home Phone #
Camper Email
Address
City State    Zip
GPA SAT/ACT Scores
Parent's Names
Parent's Email
Parent's Cell
Travel Ball Team Coach/Phone
Referred By
3 roommates
 

Medical Insurance Coverage (Required)

Company Name
Policy #
Allergies
Medical Conditions
 

*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 1, 2011, $490 thereafter; pitcher/catcher add $100

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