Millersville University

Sign up for the 2010 RAD Field Hockey Camp online!  

Before submitting your information, please print the camp brochure, fill out the medical/insurance release and mail it to Shelly Behrens, Field Hockey Coach, Millersville University, Jefferson Hall, 164 West Cottage Ave., Millersville, PA 17551.

Camp Name *	Select... RAD Field Hockey Camp
Camper Type	Select... Resident Extended Day Camper
Last Name *
First Name *
Address *
City *
State *
Zip Code *
Primary Phone Number *
Alternate Phone Number
E-Mail
Participant Age *
Grade at Time of Event *
Position *
T-Shirt Size (not available for clinics) *
Roommate Preference (camps only)
Current School Attending *
First Year of College? *	YesNo
Club Team
Years Played (varsity, JV, middle school, other) *
Emergency Contact Information
Parent/Guardian Contact *
Address *
City *
State *
Zip Code *
Emergency Primary Phone *
Alternate Phone
Insurance Company Covering Participant *
Insurance Policy Number that Covers Participant *
Medical Concerns/Injuries *
Allergies *
Method of Payment
Payment Type *	Select... Check Credit Card