O'Dea Academic & Enrichment Summer Camps
Participant's Name
First Name
Last Name
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade in Fall 2024
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5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
Current School
T-Shirt Size
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Youth Small
Youth Medium
Youth Large
Youth XL
Adult Small
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Camp Selection & Payment
Camp Selection
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Your Brains & You: Exploring Neuroscience
$
100.00
June 17th-21st
Canva Creative Studio
$
150.00
July 8th-11th
Maker Space Camp
$
150.00
July 8th-July 12th
Discovering Forensic Science
$
50.00
August 15th & 16th
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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Medical Release
I verify that [participant]
Participant
Is medically insured with
Provider
Policy number
Policy Number
Has dental insurance with
Provider
The above insurance effectively covers any medical or dental cost incurred as a result of participation in the O’Dea Baseball Clinic. Further, I authorize the Coaching staff to seek any necessary emergency medical or dental treatment my child may need during the course of camp.
Current Medications
Current Allergies
Acknowledgement of Risk
As the Parent/Guardian of [participant]
I acknowledge the potential risk of injury related to participating in football and the physical activities associated with participation in the O’Dea Baseball Clinic. I knowingly and voluntarily on behalf of the camp participant accept the risk of all such injuries that could occur due to participation in the camp.
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