Infield Camp - August 21

We collect demographic information for grant reporting purposes only; individual data is never used—only combined data is reported as a whole.
Player Name

First NameLast Name
Birthdate

MonthDayYear
Date
Gender
Race
This is used for Grant Purposes
Grade
School
Student ID

Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Any Medical Conditions or Allergies
Please put NONE if not applicable
Health Insurance Carrier
Health Insurance Policy Number
Who will be picking up your child from camp?

First NameLast Name
CY-HOPE 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.

CY-HOPE MEDIA 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 21 Camp for Ages 12-15

$25.00

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