Registration for Girls Softball Camp

Please fill out the form below to register for Lees-McRae's 2013 High Country Softball Day Camp, scheduled for June 11-13. The High Country Softball Day Camp is open for campers ages 8-14.  The camp will offer instruction in all skills in the game, including throwing, hitting, running, pitching, and catching, and will run from 9 a.m. until 4 p.m. The cost of the camp is $85 per camper.


Personal Information

Email address *
First name *
Last name *
Address 1
Address 2
City
State
ZIP Code
Home Phone
Alternate Phone
Birthdate
Shirt Size *
Covered under Medical Insurance? *
If yes, please specify your provider and policy information in the fields below
  Yes
  No
Insurance Provider *
Enter N/A if not applicable
Policy Holder Name *
Enter N/A if not applicable
Policy Number *
Enter N/A if not applicable


Custodial Parent/Guardian Information

Registrant is in the custody of
If provided options do not apply, complete the next field
  Both parents
  Mother only
  Father only
Other
Mother/Guardian Name
Daytime Phone
Work Phone
Father/Guardian Name
Daytime Phone
Work Phone


Medical Information

Please list medications *
Please list allergies *
List any known physical limitations or concerns that we should be aware of


Emergency Contact Information (other than guardian)

Full name
Home Address 1
Home Address 2
City
State
Zip
Primary Phone
Alternate Phone
Relationship to camper


Waiver of Responsibility

I agree Lees-McRae College and its athletic department is released from liability in connection with medical treatment and unavoidable accidents.  Lees-McRae College High Country Softball Day Camp also has my permission to use necessary medical measures in the event of an emergency, for which I will be financially responsible.

I fully understand the inherent risks involved in the activities my child will be participating in for this softball camp. I accept all risks including those activities preliminary and subsequent to the activity.  

I do hereby further declare [provide child's full name below] to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent their participation, with or without reasonable accommodation of any disability, in any of the activities and programs of the Lees-McRae College High Country Softball Day Camp. I do hereby assume all responsibility for this child’s participation and activities, and his/her use of equipment in activities. *

Also, I give the Lees-McRae College softball program permission to utilize my child's photograph or likeness in camp promotional materials.

Parent or Guardian Electronic Signature *
Date *

PLEASE MAKE CHECKS PAYABLE TO:

Lees-McRae Athletic Camps

PLEASE MAIL TO
OR BRING TO FIRST DAY OF CAMP CHECK IN:

Lees-McRae College High Country Softball Camp
Attn: Merritt Yackey
PO Box 128
Banner Elk, NC 28604

 
* = required field