Application Form
        (ONE Form per Camp per Camper)                                                    CLARK
        SUBMIT FORM BY MAY 31st

Camper’s Name:

City:                        Zip Code:

Phone/Cell #:

Email:                                                                                      2011
Emergency Contact:
Medical History:

Grade (Fall 2011):
                                                                                                June 6-9
    CAMP              DATE            FEE        X                                             Grades 7-12
 Baseball         June 8-10           $30
 Football         June 6-9            $40                                                      Soccer
 Soccer(3-5)      June 13-15          $40                                                June 13-15    June 20-22
 Soccer(6-8)      June 20-22          $40                                                Grades 3-5    Grades 6-8

                                                           Clark Montessori Athletics
                                                           5425 Winton Ridge Lane

Shirt Size:       Adult/Youth        S M L XL
                                                             Cincinnati, OH 45232

                  (Circle one)        (Circle one)                                              June 8-10
I hereby authorize the coaches of Clark Montessori                                              Grades 6-9
School and Cincinnati Public Schools to act for me                                       *Includes Reds Game Ticket
according to their best judgment if my child requires
medical attention. I hereby waive and release the school
and coaches from any and all liability for any injuries
incurred while my son/daughter is attending camp.
                                                                                          Grade Entering Fall 2011

Parent Signature                             Date
               Baseball                                            Football                                         Soccer

For: Boys ONLY Grades 7-9                           For: Boys ONLY Grades 7-12                          For: Boys & Girls Grades 3-5
Cost: $30                                           Cost: $40                                           Cost: $40
Dates: June 8-10 *                                  Dates: June 6-9                                     Dates: June 13-15
Time: 9am-12pm                                      Time: 6-8pm                                         Time: 6-8pm
Location: Brandon Phillips Field                    Location: Clark Montessori Fields                   Location: Clark Turf Field
Address: 5425 Winton Ridge Lane                     Address: 5425 Winton Ridge Lane                     Address: 3030 Erie Avenue
(Behind Clark Montessori HS)                        (Behind Clark Montessori HS)
*Camp will include a ticket to the Reds             Need to bring:
vs. Cubs June 8th 12:35pm                                                                               Need to bring:
Need to bring:                                          Water Bottle                                        Soccer Ball
    Bat/Glove                                           Cleats and Shoes                                    Water Bottle
    Cleats and Shoes

                                                            Mailing Address
      Clark Camps Philosophy
                                                         Clark Summer Sports Camps
The emphasis of Clark camps will be learning                                                                        Soccer
                                                     Attention: (Specific Camp Attending)
the fundamentals of each individual sport and             5425 Winton Ridge Lane
 having fun. We believe that in order to reach              Cincinnati, OH 45232                        For: Boys & Girls Grades 6-8
                                                                                                        Cost: $40
your full potential as a future Clark Athlete you     Make Checks Payable To:
                                                      Clark Montessori Athletics Boosters               Dates: June 20-22
must have a solid foundation of fundamentals.                                                           Time: 6-8pm
                                                        Application Deadline:
 Campers will be given a variety of individual                                                          Location: Clark Turf Field
                                                              MAY 31, 2011
  methods of practicing that will enable all to         Walk-ups will be ACCEPTED                       Address: 3030 Erie Avenue
                                                      (Please email Athletic Dept. if plan to attend)
 practice at home on their own. We hope you
                                                               Questions:                               Need to bring:
     first and foremost have an enjoyable                     Contact Corey Parker                          Soccer Ball
                  experience!                                   (513)363-7138
                                                                               Water Bottle

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