E\East Peoria High School Softball Summer Camp Location: EastSide Centre



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E\East Peoria High School Softball Summer Camp Location: EastSide Centre

East Peoria High School Softball Summer Camp Location: Eastside Centre





East Peoria High School

Summer Softball Camp

June 16th- June 19th 2014

Grades: 3rd – 8th



Camper Information


Any questions or concerns please contact Coach Menzione, the head varsity softball coach at East Peoria High School at: menziden@ep309.org

Camper Name:




Date of Birth:







E-mail address:



Home Phone:

( )

School/Grade:




T-Shirt Size:




Position(s):



Summer Camp Information:


Grades: 3rd – 8th

Dates: June 16th - June 19th

Times: 8am – 10am

Location: Eastside Centre

Cost: $55.00 (please make checks payable to EPCHS Softball)

Emergency Contact Information:

Emergency Contact Name/Phone Number:




Physician Name/Phone Numer:




Insurance Company:




Medical Conditions:




I hereby authorize the directors and staff of the Raider Softball Camp to act for me according to their best judgment in any emergency requiring medical attention, and I hereby release the Raider Camp, the directors, staff, and others related thereto and the camp facilities from any and all liability for any injuries, accidents, and/or illnesses incurred while at camp. I will be responsible for any medical or other charges in connection with my child’s attendance. I know of no mental or physical problems that might affect my child’s ability to safely participate in this program.

Parent/Gaurdian Signature:

Date:


Please return with form and checks to:

EPCHS

Attn: Denee Menzione

1401 E. Washington Street

East Peoria, IL 61611

Any questions or concerns please contact Coach Menzione, the head varsity softball coach at East Peoria High School at: menziden@ep309.org

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