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July 12-15, 2004 NAME ______________________________________ MAILING ADDRESS _________________________________________ CITY _______________________________________STATE ______ ZIP _____________ HOME PHONE _____________________EMAIL__________________________________ SCHOOL_______________________________ SCHOOL GRADE SEPTEMBER 2004 ________ AGE ______ POSITION (S) _________________ TOTAL $ ENCLOSED _______________ (Payment due with application) PAYMENT METHOD Check or money order ______________ Amount enclosed Card Number ________________________________ Expiration ___________ Cardholder Signature
_____________________________________________ I recognize that there are certain dangers, risks and possible injuries which are inherent in and may result from participation in camp activities. I understand that despite the safety precautions taken by Eastern Kentucky University and/or camp personnel that it is impossible to guarantee that any camp participant will not be injured. I have instructed my child to obey all rules, regulations and instructions of camp personnel in and effort to minimize such risks. I/My child is in good physical health and fitness such as to allow him/her to participate in camp activities. In the event of possible injury, I give permission for the administration of emergency medical care to my child/me and understand that I will be responsible for any and all medical expenses. ____________________________________________________________ Visit us at http://www.softball.eku.edu/ for Inside EKU Softball |