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Camp Brochure in PDF FormatCamp Application in PDF FormatPrinter-Friendly Version

Name: _______________________________________________________
Address: _____________________________________________________
City: ________________________________________________________
State: ____ Zip: ________ T-shirt Size: _________________
Phone Number: (________) ______________________________________
Height: _______ Weight: _______ E-Mail: ______________________
Age: ___________ High School Graduation Year: ___________________
Camp Attending: (Circle One Only)
Youth Developmental Camp: June 21 – 25, Monday – Friday $175.00
Developmental Camp: June 27 – July 1, Sunday – Thursday $220.00
High School Elite Prospect Camp: June 25 – 27, Friday – Sunday
(Please specify boarder or non-boarder)
Boarders: *Lodging and meals included $325.00
Non-Boarders: *Meals excluding breakfast included $275.00

Please make checks payable to:
Atlantic Coast Camps
McCue Center/Virginia Baseball Office
P.O. Box 400839
Charlottesville, VA 22904-4839

I understand the Atlantic Coast Camps, L.L.C. is not a function of the University of Virginia and that the University of Virginia is not responsible for camp activities. In partial consideration of our child’s acceptance into Atlantic Coast Camps, L.L.C.’s Summer Developmental and Elite Prospect Camps, I/we as parents and/or legal guardians of ___________________________________________ do hereby agree that I shall be responsible for all costs associated with any injury or loss that may be sustained by my child/ward as a result of the use of facilities at the University of Virginia. I also agree to limit the liability of Atlantic Coast Camps, L.L.C., and its employees, managers, agents, officers, staff and physicians, to the actual coverage of the medical insurance policy covering participants in the Summer Developmental and Elite Prospect Camps as explained in the brochure, which we have read and understand. I/we further agree to waive all liability of Atlantic Coast Camps, L.L.C., its employees, managers, agents, officers, staff and physicians, for any accident, injury (including death), illness or other mishap which might befall the above-named camper while traveling to or from, or during his attendance at the Summer Developmental and Prospect Camps, which is not covered by said medical insurance policy.

Further, I/we hereby grant permission to the staff and physicians assisting the Summer Developmental and Elite Prospect Camps, any medical or surgical consultant deemed advisable, and any hospital to render to the above-named camper any medical and surgical treatment that they deem necessary. I/we understand that all possible effort will be made to inform me/us in case of such treatment.

Parent or Legal Guardian’s Name (printed) _______________________________________
Signature __________________________________________________________________
Day Telephone: (________)____________________________________________________
Night Telephone: (________)___________________________________________________
Emergency Contact: __________________________________________________________
Emergency Telephone: (________)______________________________________________

To be completed and signed by camper’s parents or legal guardian

__ Asthma __ Diabetes __ Heart Disease __ Rheumatic Fever
__ Bleeding Disorders __ Convulsions/Seizures __ Head Injury/Concussions
Allergies to Drugs: ____________________________________________________________
Allergies to Foods: ____________________________________________________________
Last Tetanus Immunization (date): _______________________________________________
Current Medications: __________________________________________________________
Chronic or Recurring Illnesses: __________________________________________________
Operations/Injuries (include dates): _______________________________________________
Physical Restrictions*: __________________________________________________________
Physician Telephone (________)___________________________________________________
Dentist Telephone (________)_____________________________________________________
Medical Insurance ______________________________________________________________
Policy Number _________________________________________________________________

This health history is correct to the best of my knowledge, and my son has my permission to participate in camp activities with the exception of those noted above*. I authorize Atlantic Coast Camps, L.L.C., to release medical information regarding the above named participant to its employees, managers, agents, officers, staff and physicians, and to other interested parties who may reasonably request it, including, without limitation, other parents and the family physician of any camper.

Parent or Legal Guardian Must Sign Here: __________________________________________
I have read and I understand the camp program and application process as described in this brochure.
Parent or Legal Guardian Must Sign Here: __________________________________________
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