Ballard High School Field Hockey

Future Bruin Camp/Try-out Prep

July 12-13, 2021

Incoming Freshman:
4:30pm-6:30pm
6000 Brownsboro Road
Louisville, KY 40222

Camp Director
Ballard Field Hockey Head Varsity Coach- Allison Masyada

All incoming freshman are invited to participate in Ballard's preseason field hockey
camp. This camp includes two intense days of skill reinforcement, tactical review,
and tryout preparation. Ballard Field Hockey coaches will be in attendance to ask
any questions regarding the 2021 field hockey season or tryouts.

Tuition Equipment Required

Players must provide the following equipment:
Individual Player: $65*
Outdoor Field Hockey Stick*
Please make all checks payable to:
Mouth Guard*
“Ballard Field Hockey, Inc.” Shin Guards*
Goalie Gear (if goalie)*
Mail checks and completed registration RUNNING SHOES (no cleats)*
form to: Water Bottle
Sunscreen
Treasurer Michelle Shuler Ice Towels** (water cooler with wash
Ballard Field Hockey Camp cloths)
5111 Wolf Pen Woods Dr.
*Camp participation will be limited for campers who
Prospect, KY 40059 have the proper equipment

**Risk of possible dehydration due to extreme heat

Questions? ballardfieldhockey@gmail.com
Camp Weather Updates? Follow us on Twitter: @BRUINFH & Facebook: Ballard Field Hockey
 PARENTAL CONSENT
Please complete the following information in order to enable healthcare facilities in Louisville to
provide prompt emergency care to your minor child in the event of an accident, injury or illness.

Camper Name: ___________________________________________________________________

Person to notify in case of emergency: ________________________________________________

Relationship:___________________ Phone:_____________________________

Special Medical Concerns/Allergies/Injuries:___________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Child’s Physician: _______________________________ Physician’s Phone: _________________

Insurance Company: _____________________________ Policy #: _________________________

Name of Policy Holder: ________________________________

Signature of Parent/Guardian: ___________________________________ Date: ____________

 REGISTRATION

Camper Name: ________________________________________________________________________

Address: ______________________________________________________________________________

Parent’s Phone: ___________________ School/Team: ________________________________________

Grade (2021-2022):______________ Age:____________

Parent’s Email:___________________________________________________________

Camper’s T-Shirt Size (circle one): Youth S M L Adult S M L

(t-shirts cannot be guaranteed for late registrations)

I, the undersigned, hereby certify that I am the parent or legal guardian of ___________________________
and give permission for the staff of the 2021 Ballard Field Hockey Camp, during the period of the camp, to
seek appropriate medical attention for my child in the event of an accident, injury or illness and for my child
to receive medical attention in the event of such an accident, injury or illness. I will be responsible for any
and all of the costs of the medical attention and treatment and have medical insurance to cover the costs.

I, as the parent or legal guardian of my child, understand that field hockey is an active physical sport, and
that injuries can take place during play. I also understand that there will be a number of children attending
the camp, there will be a limited number of coaches and counselors, and that my child cannot receive
individual attention and supervision all the time. I understand that as with any sport, injuries can occur, and
I hereby acknowledge that my child is physically fit and mentally capable of participating in field hockey
and camp activities. I hereby represent that I have sought the opinion of my child’s physician and he/she
concurs that my child is fully capable of safely engaging in these activities. I hereby give permission for my
child to participate in the 2021 Ballard Field Hockey Camp and do hereby release, waive and discharge the
Ballard Field Hockey Camp, its staff and administration, the Ballard Field Hockey Booster Club, Ballard
High School, its staff and administration and the Jefferson County Public School System from all rights and
claims for damages, accident, injury or loss to personal property which may be sustained or occur during
participation in the Ballard Field Hockey Camp.

Guardian Signature: ________________________________ Date:_____________________________