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2008 Brad Horky’s
Softball Camp Camp Ages: 8 - 18. All areas of the game will be covered with individual attention provided to each camper. The camp features advanced, individual instruction as well as a complimentary t-shirt. Camp instructors feature Pitt State head coach Brad Horky and current PSU assistant coaching staff and current Gorillas players. Cost of the camp is $35. Due to the individual focus of the camp, registration will be limited to the first 20 athletes who register and return the liability release form below. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Registration Form Name:____________________________________________________________________ Address:_________________________________________________________________ Email:___________________________________________________________________ Phone:____________________________Cell Phone:____________________________ Age:_____________High School:____________________________________________ Position(s):____________________Summer Team:_____________________________ T-Shirt Size:___________________ Return to: Pittsburg State University Softball Office - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2008 Brad Horky’s Softball Camp at Pittsburg State
University I hereby authorize by child______________________________________to participate in the 2008 Brad Horky’s Softball Camp at Pittsburg State University on March 25, 2008. I understand that in signing this form that I release Brad Horky and Pittsburg State University from all liability and responsibility for any injuries that may be incurred while participating in the above mentioned camp. I also acknowledge that Pittsburg State University, Brad Horky, and their insurance companies, are not financially responsible for medical care provided for pre-existing injuries or conditions, medical treatment for conditions considered to be congenital or hereditary in nature, or injuries incurred during the course of the camp. The following information and authorization must be fully completed, signed and returned: Parent/Guardian Name:___________________________________________________________ Home Phone:______________________________Other:_________________________________ Emergency Contact:_______________________Contact Number:________________________ Name of Group Insurance Company:________________________________________________ Group #:_________________________________Policy #:______________________________ Is your daughter covered under the above-mentioned policy? YES________NO________ I also grant permission for treatment (coaching staff) deemed necessary for a condition arising during participation in the above mentioned camp, including medical or surgical treatment recommended by a doctor. I understand that every effort will be made to contact me prior to treatment. Parent/Guardian Signature_____________________________________Date_______________ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FOR
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