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INDIANA FIELD HOCKEY CAMP

IU Field Hockey Team Camp

Ages 14-18

July 24-27, 2013, Bloomington, Indiana, at Indiana University

FOR REGISTRATION INFORMATION:

Phone: 1-812-856-2171
E-Mail: Click Here!
Register On-Line: Now Available!
What to Bring to Camp: Click Here!
Download Camp Brochure: Click Here!

TO CONTACT COACH ROBERTSON:

Phone: 1-812-856-2171
E-Mail: fieldhoc@indiana.edu
Mail Questions To:
Indiana Field Hockey Camp
Athletic Dept., Indiana University
1001 East 17th Street
Bloomington, IN 47408



** At least 13 team members necessary to select team rate

* Add 6% for on-line registrations

All IU Camps are open to all and any entrants

2013 Indiana Field Hockey Camp

INDIANA FIELD HOCKEY CAMP REGISTRATION - JULY 24-27, 2013

Registration Note - Registrations will be accepted until the camp is full. No refunds or cancellations will be accepted less than two weeks prior to the start of camp. Cancellations received two weeks prior to the start of camp will receive a refund of the registration fee minus a $75 administrative fee. No refunds will be made if a child is withdrawn within two weeks of the start of each camp.

If you have questions, please call 812-856-2171.

Please complete the form below and submit camp payment.

 
Payment Option (select one)*
 Credit Card
 Mailing in check*
 
* If you are mailing in a check, completely fill out this form and click on the 'register' button at the bottom of the page. On the next page, you can exit your web browser. Then, you can mail in your check made payable to Indiana Field Hockey Camp to: Indiana Field Hockey Camp; 1001 E. 17th Street; Bloomington, IN 47408. As a reminder, the IU Field Hockey Camp rate is $470 for teams (13 or more) and $495 for individuals. In the memo line of your check, please indicate the name or names that payment is for.  

INTERNAL USE - Campers DO NOT fill out this field!  
Check Received (Check #, Date, Amount)
 
Camper's Name (Last, First)*
 
E-Mail Address*
 
Birthdate (Month/Day/Year)*
 
H.S. Graduation Year*
 
Position (select one)*
 Back
 Midfield
 Forward
 Goalkeeper
 
Experience (select one)*
 HS Varsity - 3 years
 HS Varsity - 2 years
 HS Varsity - 1 year
 JV - 3 years
 JV - 2 years
 JV - 1 year
 Jr. High - 3 years
 Jr. High - 2 years
 Jr. High - 1 year
 Beginner
 
Parent/Guardian Name(s)*
 
Home Address*
 
City*
 
State*
 
Zip*
 
Emergency Contact (Name, relationship, phone #)*
 
Home Phone #*
 
Parent's Cell Phone # *
 
Team Competing with at IU Field Hockey Camp (if registering as an individual, list your school)*
 
Roommate Preference (only one)
 
T-Shirt Size (adult sizes)*
 S
 M
 L
 XL
 XXL
 

PARENTAL CONSENT FORM
In order to enable health facilities in Bloomington to provide prompt care to your daughter, we urge you to read and complete this Consent Form. This will enable us to help your child without delay in the event of an emergency.
 
Name of Minor*
 
Social Security # (if used by insurance)
 
Insurance Company*
 
Name of policy holder*
 
Policy Number/Group #*
 
Allergic Reactions
 
Present Medication (if taking now)
 
Date of Last Tetanus Toxoid
 

* I grant permission to the Directors, Assistants, or other persons responsible for her care to act on my behalf for said minor in granting permission for evaluation and treatment of medical problems. I understand that should a major medical problem arise, an attempt will be made to notify me by telephone. In the event that I cannot be reached, I hereby give my consent to such medical treatment as deemed necessary, including surgery, x-ray examinations and anesthesia to be rendered to said minor by a licensed physician or nurse.  

* Waiver: In consideration of being allowed to participate in the IU Field Hockey Camp, I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge and covenant not to sue Indiana Field Hockey Camp, Forward Marketing LLC, its officers, employees and agents for liability from any and all claims including the negligence of the IU Women's Field Hockey Camp, Forward Marketing LLC, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in the IU Field Hockey Camps.  

Parent/Guardian Name*
 
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 IU Field Hockey Camps are cancelled for any reason, refunds must be collected directly from the IU Field Hockey Camp, Phone 812-856-2171.
 
Qty 
 $498.00 Option 1 - Team Camper Registration (note: at least 13 players from your team must be attending to get the Team Camper rate)

 $525.00 Option 2 - Individual Camper Registration