<p> Steve Jennings 2015 Field Hockey clinics Application</p><p>Space is limited! To secure your spot in camp, please return this portion of the application along with your non-refundable deposit to: Steve Jennings Field Hockey Camp American University 4400 Massachusetts Avenue, NW Washington, DC 20016</p><p>August 1-2 Score & Save Clinic August 3-6 Overnight Camp ($150 Deposit) ($250 Deposit)</p><p>Name:______Address:______City:______State:_____ ZIP:______Home Phone______Best email to send confirmation materials:______Grade in September 2015:_____ High School:______Years of Experience:______Preferred Position:______</p><p>Emergency Contact:______Emergency Phone:______Emergency Contact #2:______Emergency Contact #2 Phone:______Health Insurance Co.:______Policy #:______</p><p>Parent/Guardian please read and sign:</p><p>I, the undersigned, hereby certify that I am the parent or legal guardian of the camper. I understand and accept that the risk of injury is possible while playing or practicing the sport of field hockey. I hereby give permission for the staff of the steve Jennings field hockey camp to seek during the period of the camps appropriate medical attention for the camper in the event of accident, injury or illness. I will be responsible for any and all costs of medical coverage policy. ______Parent/Guardian signature Date ______Print name Relation</p>