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Sponsored By:   O'Neills : Official supplier for New York Minor Board County Teams
Yonkers, Ny
 
 
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2019 NYMB Gaelic Park Cul Camp Registration Form

 

July 1,2,3rd Hurling Camp (5-14yrs) Gaelic Park (9AM-1pm)________________________

July 8-12th July Football and Hurling Camp Gaelic Park (5-11yrs)____________________

July 15th-July 19th Football +Hurling  (5-11yrs): Gaelic Park (9am – 1pm)  ______________________

 

Player(s) Name_________________________

 

Kit Size: Age 6 ____ Age 8  ____  Age 10 ____  Age 12 ____ Age:14 ___           

Parent Name__________________

 

Football Only $ 120 for each child (additional children $100)

Hurling/Camogie $ 75 (Please bring own- extra helmets and equipment supplied)

Football Camp & Hurling/Camogie Camp = $ 180

Checks Payable to the NY Minor Board

 

For Further Information on Cul Camps please contact New York GAA Games Development Officer Simon Gillespie on 9145738761 thanks!

Please keep this form with you as proof of purchase of Cul Camp 2019

 

 

 

 

 

 

                                                                                   

 

 

 

2019 NYMB Cul Camp Player Information and Medical Release Form

Player's Name:____________________________ Date of Birth:______________________

Address:_________________________ City:__________ State:__________ Zip:__________

Which New York Minor Board / Gaelic for Girls Club are you affiliated to:_______________________

Which camp are you signing up for ?

Hurling Camp              Gaelic Park Football and Hurling Camp:

Kit Size: Size 6:                  Size 8               Size 10                Size 12                    Size 14

Did you participate in CUL CAMP NYC 2018?___________

Payment (please tick :   Cash             Check              Total 2018 Amount Paid__________

EMERGENCY INFORMATION (PLEASE INCLUDE AREA CODE)

Contact Name 1:  _____________

Contact Name 2______________

Contact 1 Cell Phone: ()___________________ Contact 2 Cell Phone: ()__________________

Email address to receive notifications on Cul Camp to___________________________________

In an emergency, when Contacts cannot be reached, please contact:

Name:_____________ Home Phone:___________________ Work Phone:____________________

Allergies:__________________________________________________________

Other Medical Conditions:_______________________________________________

Player's Physician:___________________________________________________

Work Phone:______________________ 2nd Phone:_______________________________

Medical and/or Hospital Insurance Company:__________________________ Phone:.

Policy Holder:_________________ Policy #:_______________ Group #:_______

PLEASE COPY BOTH SIDES OF YOUR MEDICAL INSURANCE CARD AND ATTACH TO THIS FORM                               PARENT'S APPROVAL AND MEDICAL RELEASE

Recognizing the possibility of physical injury associated with Gaelic Football and in consideration for the New York Minor Board and its affiliates accepting the registrant for participation in its program and activities. I hereby release, discharge and/or otherwise indemnify the New York Minor Board, its affiliated organizations and sponsors, their employees and associated personnel, including the owner of fields and facilities utilized for the Programs against any claim by or on behalf of the registrant as a result of the registrant's participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.My son/daughter has received a physical examination by a physician and has been found physically capable of participating in the Programs. I hereby give my consent to have the manager and /or doctor of medicine or dentistry provide my son/daughter with medical assistance and/or treatment and agree to be responsible financially for the reasonable cost of each assistance and/or treatment.

Signature of Guardian_____________________             _Can you volunteer time (Y / N ) Dates available: