2010 INDIANA FIELD HOCKEY CAMP


FOR REGISTRATION INFORMATION:

Phone: 1-812-856-2171
E-Mail: Click Here!
Register On-Line: Now available!
Download Camp Brochure: Click Here!

TO CONTACT COACH ROBERTSON:

Phone: 1-812-856-2171
E-Mail: adrobert@indiana.edu
Mail Questions To:
Indiana Field Hockey Camp
Athletic Dept., Indiana University
1001 East 17th Street
Bloomington, IN 47408



** At least 13 team members necessary to select team rate

Add 6% for on-line registrations

All IU Camps are open to all and any entrants

REGISTRATION CLOSED as of July 14, 2010

INDIANA FIELD HOCKEY CAMP REGISTRATION - JULY 22-25, 2010

Registration Note – Registrations will be accepted until the camp is full. No refunds or cancellations will be accepted less than two weeks prior to the start of camp. Cancellations received two weeks prior to the start of camp will receive a refund of the registration fee minus a $75 administrative fee. No refunds will be made if a child is withdrawn within two weeks of the start of each camp.

If you have questions, please call 812-856-2171.

Please complete the form below and submit camp payment.

 
Payment Option*
 Credit Card
 Mailing in check*
 
* If you are mailing in a check, completely fill out this form and click on the 'register' button at the bottom of the page. On the next page, you can exit your web browser. Then, you can mail in your check made payable to Indiana Field Hockey Camp to: Indiana Field Hockey Camp; 1001 E. 17th Street; Bloomington, IN 47408. As a reminder, team campers' rate is $450, while the individual campers' rate is $475. In the memo line of your check, please indicate the name or names that payment is for.  

Camper's Name (Last, First)*
 
Home Address*
 
City*
 
State*
 
Zip*
 
Camper's Home Phone
 
Father's Cell
 
Mother's Cell
 
Parent's E-Mail Address
 
Age
 
Grade Entering (as of Sept. '10)*
 8
 HS Freshman
 HS Sophomore
 HS Junior
 HS Senior
 College Freshman
 

Camper's School*
 
Experience (select one)
 HS Varsity - 3 years
 HS Varsity - 2 years
 HS Varsity - 1 year
 JV - 3 years
 JV - 2 years
 JV - 1 year
 Jr. High - 3 years
 Jr. High - 2 years
 Jr. High - 1 year
 Beginner
 

Position (select one)*
 Back
 Midfield
 Forward
 Goalkeeper
 

Roommate Preference (only one roommate allowed)
 
T-Shirt Size (unisex)
 XS
 S
 M
 L
 XL
 

PARENTAL CONSENT FORM
In order to enable health facilities in Bloomington to provide prompt care to your daughter, we urge you to read and complete this Consent Form. This will enable us to help your child without delay in the event of an emergency.
 
Camper's Name (Last, First)
 
Birthdate (Month/Day/Year)
 
Insurance Company
 
Name in which Policy is listed
 
Policy Number/Group #
 
Drug Reactions
 
Present Medication (include dosage)
 
Date of Last Tetanus Toxoid
 
If parent can't be reached, name and number of another person to contact
 

 I authorize the IU Field Hockey Camp to photograph my child in camp activities for promotional purposes. These photos will be made available on-line for parents to view (with a username and password) and purchase at the conclusion of camp. Information on the website will be distributed at the start and finish of camp.  

* Waiver: In consideration of being allowed to participate in the IU Field Hockey Camp, I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge and covenant not to sue Indiana Field Hockey Camp, Forward Marketing LLC, its officers, employees and agents for liability from any and all claims including the negligence of the IU Women's Field Hockey Camp, Forward Marketing LLC, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in the IU Field Hockey Camps.  

MEDICAL CONSENT FORM
Please select one of the following two choices  

 I grant permission to the Directors, Assistants, or other persons responsible for her care to act on my behalf for said minor in granting permission for evaluation and treatment of medical problems. I understand that should a major medical problem arise, an attempt will be made to notify me by telephone. In the event that I cannot be reached, I hereby give my consent to such medical treatment as deemed necessary, including surgery, x-ray examinations and anesthesia to be rendered to said minor by a licensed physician or nurse.  

 I authorize limited care as follows  
Limited Care Notes
 
Parent/Guardian Name*
 


PAYMENT OPTIONS
Please select your payment option by indicating a '1' in the quantity field. We need a registration form and consents completed for each participant.

Note: A charge from either Forward Marketing or HoosierSportsCamps.com will appear on your credit card for your on-line registration. However, if any of the IU Field Hockey Camps are cancelled for any reason, refunds must be collected directly from the IU Field Hockey Camp, Phone 812-856-2171.
 
Qty 
 $503.00 IU Field Hockey Individual Camper Payment in Full

 $477.00 IU Field Hockey Team Camper Payment in Full