Hempfield Rec / Youth Camps & Clinic Request Form - Hempfield recCenter

Youth Camps/Clinic Request

Requestor / Coach(Required)

First Last

Payee (Person / Booster Club to be paid)(Required)

EIN (Booster) or Social Security # (personal)

Payee Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

Phone(Required)

Email(Required)

Name of Camp / Clinic(Required)

Description of Camp / Clinic(Required)

Ages / Grades(Required)

Start Date(Required)

End Date(Required)

Start Time(Required)

End Time(Required)

Will a fee be charged?(Required)

Yes

Fee (if applicable)

Location(Required)

Min / Max Participants(Required)

Liability insurance uploaded into FMX?(Required)

Yes