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GENERAL INFORMATION Indian Hill Athle-c Department is sponsoring Summer Camps across a variety of sports and ages. All interested campers should fill out the waiver and registra-on form a?ached and mail back with payment to: Indian Hill Athle-c Department 6855 Drake Rd. Cincinna-, OH 45243 Payment can also be made via EZ Pay -­‐ hHps://
www.spsezpay.com Please contact the Indian Hill Athle-c Department 513-­‐272-­‐4631 Please make separate checks for all camps. Indian Hill Braves 2015 Indian Hill Summer Sports Camps 6855 Drake Road. Cincinna2, OH 45243 513-­‐272-­‐4631 Indian Hill Summer AthleDc Camps Volleyball – IH High School Gym Date: June 1 – June 4 Grades: 4 – 8 Time: 3 – 6 pm Cost: $100/camper Contact: Coach Ellen Hughes ellen.hughes@ih.k12.oh.us Girls Soccer – Shawnee Soccer Stadium Date: June 1 -­‐ 4 Grades: 4 – 8 Time: 5 – 7:30pm Cost: $100/camper Contact: Coach Amy Dunlap amy.dunlap@ih.k12.oh.us REGISTRATION/WAIVER Camp Name ______________________________________________ Name of Camper __________________________________________ Age _________ Grade in Fall 2015 _______________ Parent/Guardian Name ______________________________________ Address ____________________________________________________ Zip __________________ Home # _____________________________ 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 tburch228@yahoo.com 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 tony.arcuri@ih.k12.oh.us 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 Sco` Lloyd slloyd@luxobcaretail.com 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 r.smith@prasco.com Cheerleading -­‐ IH Middle School Gym Date: Aug 3 – Aug 7 Grades: 1 – 8 Time: 9 – 12 pm Cost: $100/camper Contact: Coach Kristen Bratcher kristenbratch@gmail.com 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, understand that this ac2vity 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 consent to medical, surgical and/or dental examina2on, in addi2on to any and all other treatments that may be deemed necessary by medical personnel. In addi2on, I understand that by signing this agreement, I hereby knowingly release and discharge Indian Hill Exempted Village School District from any and all liability resul2ng from any injury associated with the above named individual's par2cipa2on in this ac2vity. Indian Hill Exempted Village Schools will not provide health and/or accident insurance for program par2cipants. By signing below, I abest that I have read and fully understand and agree to the assump2on of risk, waiver and release of all claims set forth herein. Parent/Guardian Print Name _________________________________________ Sign Name __________________________________________ PLEASE RETURN THIS COMPETED FORM AND SEPERATE CHECK FOR EACH CAMP MADE PAYABLE TO: Indian Hill Athle-c Department 6855 Drake Rd. Cincinna-, OH 45243