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INDIANA TRACK AND FIELD CAMPS

2012 HOLIDAY CAMP SESSION II - AM Session (9 a.m. - 12 p.m.)

December 27-29, Bloomington, Indiana
at Gladstein Fieldhouse

EVENTS COVERED

- Hurdles
- High Jump
- Long Jump
- Triple Jump
- Blocks
- Sprints
- Middle Distance
- Distance

FOR REGISTRATION INFORMATION:

Phone: 812-855-8583
E-Mail: Click Here!
Register On-Line: Now Available!

$25 summer camp discount if coming with at least five teammates

TO CONTACT IU TRACK AND FIELD:

Phone: 812-855-8583
E-Mail: Click Here!
Mail Questions To:
Indiana Track and Field Camp
Athletic Dept., Indiana University
1001 East 17th Street
Bloomington, IN 47408



All IU Camps are open to all and any entrants

* Add 6% convenience fee for credit card payments

Holiday Camp II - AM Session

Registration Note: Your camp fee, less a 50% non-refundable administrative deposit will be refunded without question, if you cancel at least two weeks prior to the beginning of camp. At any time after that date, refunds (less the 50% administrative fee) will be made for medical reasons only and must be accompanied by a signed medical statement from your physician within 30 days from the start of camp. If no request for cancellation is made before the camp begins, absolutely no refunds will be given.  

Days Attending Camp*
 Both Days
 Jan. 2 Only
 Jan. 3 Only
 
If you are not doing the three-day weekly option, please list day or days you'll be attending here
 
Camper's Name (Last, First)*
 
Home Address*
 
City*
 
State*
 
Zip*
 
Camper's Home Phone*
 
Parent's E-Mail Address*
 
Age*
 
Grade Entering (as of Sept. 2012)*
 
Primary Event(s)*
 
EMERGENCY NUMBERS  
Father's Home Phone #
 
Father's Cell Phone #
 
Father's Work Phone #
 
Mother's Home Phone #
 
Mother's Cell Phone #
 
Mother's Work Phone #
 
INSURANCE INFORMATION  
Insurance Company*
 
Policy Number/Group #*
 
Name of policy holder*
 
Any past illness or other information that would be useful in the event of medical treatment
 
Allergic Reactions
 
Present Medication (include dosage)
 
WAIVER AND RELEASE  

* I, the undersigned, submit that my son or daughter is physically fit to participate in strenuous athletic activity and I waive the HoosierTrack and Field Camp from any and all responsibility for injury or illness. I hereby authorize the directors of Hoosier Track and Field Camp to act for me according to their best judgment in an emergency requiring medical attention. I understand that I am solely responsible for the payment of such medical expenses and provide Hoosier Track and Field Camp proof of medical and accident insurance. I also understand my payment is subject to a 50% handling fee.  
Parent/Guardian Name*
 
Date*
 
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 Hoosiersportscamps.com will appear on your credit card for your on-line registration. However, if any of the Hoosier Track and Field Camps are canceled for any reason, refunds must be collected directly from Hoosier Track and Field Camps, 1001 E 17th St., Bloomington, IN 47408, Phone 812-855-8583.

 
Qty 
 $105.00 Option 1 - Weekly Rate (3 days) - Payment in Full

 $40.00 Option 2 - Single Day Rate (if paying for more than one day, enter appropriate number in qty box) - Payment in Full