<p> Steve Jennings 2011 Field Hockey Camp Application Space is limited! To secure your spot in camp, please return this portion of the application along with your non-refundable deposit of $150 to: Steve Jennings Field Hockey Camp American University 4400 Massachusetts Avenue, NW Washington, DC 20016</p><p>July 5-8 Day Camp July 11-14 Overnight Camp (please circle) (please circle)</p><p>Name:______Address:______City:______State:_____ ZIP:______Home Phone______Email:______Grade in September 2011:_____ High School:______Years of Experience:______Preferred Position:______</p><p>T-Shirt size:_____</p><p>Emergency Contact:______Emergency Phone:______</p><p>Emergency Contact #2:______Emergency Contact #2 Phone:______</p><p>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>