Indian Hill Summer Athletic Camps REGISTRATION/WAIVER Camp Name ______________________________________________ Name of Camper __________________________________________ Age _________ Grade in Fall 2015 _______________ Parent/Guardian Name ______________________________________ Address ____________________________________________________ Zip __________________ Home # _____________________________ Work # ________________________Cell # ________________________ _____________________________________________________ T Shirt Size Circle One Youth S M L XL Adult S M L XL I, the undersigned parent/guardian of the individual named above, understand that this activity involves an element of risk and a danger of accidents and Injury and knowing those risks I hereby assume those risks. I authorize the program directors and/or instructors as Agents for the undersigned to consent to medical, surgical and/or dental examination, in addition to any and all other treatments that may be deemed necessary by medical personnel. In addition, I understand that by signing this agreement, I hereby knowingly release and discharge Indian Hill Exempted Village School District from any and all liability resulting from any injury associated with the above named individual's participation in this activity. Indian Hill Exempted Village Schools will not provide health and/or accident insurance for program participants. By signing below, I attest that I have read and fully understand and agree to the assumption of risk, waiver and release of all claims set forth herein. Parent/Guardian Print Name _________________________________________ Sign Name __________________________________________ PLEASE RETURN THIS COMPETED FORM AND SEPERATE CHECK FOR EACH CAMP MADE PAYABLE TO: Indian Hill Athletic Department 6855 Drake Rd. Cincinnati, OH Volleyball – IH High School Gym Date: June 1 – June 4 Grades: 4 – 8 Time: 3 – 6 pm Cost: $100/camper Contact: Coach Ellen Hughes Girls Soccer – Shawnee Soccer Stadium Date: June Grades: 4 – 8 Time: 5 – 7:30pm Cost: $100/camper Contact: Coach Amy Dunlap Boys Basketball – IH High School Gym Date: June 1 – June 4 Grades 3 – 5 9 – 11:30am Grades:: 6 – 8 12:00 – 2:30 pm Cost: $100 / camper Contact: Coach Tim Burch Girls Basketball – IH High School Gym Date: June 15 – June 17 Grades: 3 – 6 9 – 12 pm Grades: 7 – 12 1 – 4 pm Cost: $75/camper Contact: Coach Chris Arington Football – Tomahawk Stadium Date: June Grades: 1 – 5 9:00 – 10:30pm Grades: 6 – 8 10:45 – 12:15pm Cost: $75/camper Contact: Coach Tony Arcuri Cheerleading - IH Middle School Gym Date: Aug 3 – Aug 7 Grades: 1 – 8 Time: 9 – 12 pm Cost: $100/camper Contact: Coach Kristen Bratcher Baseball – IH Baseball Field Dates: June 15 – June 17 Grades: – 11:00am Grades: 7 – 8 12:00 – 2:00pm Cost: $75.00 Contact: Coach Scott Lloyd

GENERAL INFORMATION Indian Hill Athletic Department is sponsoring Summer Camps across a variety of sports and ages. All interested campers should fill out the waiver and registration form attached and mail back with payment to: Indian Hill Athletic Department 6855 Drake Rd. Cincinnati, OH Payment can also be made via EZ Pay - Please contact the Indian Hill Athletic Department Please make separate checks for all camps. Indian Hill Braves 2015 Indian Hill Summer Sports Camps 6855 Drake Road. Cincinnati, OH