Infield Camp - August 14

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Player Name

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Birthdate

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Gender
Race
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Grade
School
Student ID

Emergency Contact

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Emergency Contact Phone Number
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Any Medical Conditions or Allergies
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Health Insurance Carrier
Health Insurance Policy Number
Who will be picking up your child from camp?

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CY-HOPE MEDIA & LIABILITY RELEASE: I, the parent/guardian, of the above-named child grant Cy-Hope or its affiliated organization's permission to publish names, images, and/or videos of my child in event publications, video publications on their website, and social media outlets.

I hereby release Cy-Hope from any liability or claims for any injuries or damages incurred while participating in Cy-Hope events.
Parent/Guardian Signature

Infield Camp

August 14 - Ages 8-11

$25.00

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