National Sports Center for the Disabled - outdoor recreation opportunities for individuals with disabilities

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Date: Friday, July 30, 2010
Time: 9:30am - 12:00pm
Location: Miracle Field at Mt. Greenwood Park
3724 W. 111th St.
Chicago, IL 60655

9:30 - 10:00am	Registration & Check In
10:00 - 11:30am	Skills Clinic
11:30 - 12:00pm	Snacks & Giveaways

This free interactive camp allows kids with disabilities, either physical or developmental, ages 6-18 to experience first hand the sport of baseball. This fun-filled day will include instruction and skill development, use of equipment, games and prizes. Appearances could include players, coaches and the mascot.

Sports Camp Registration Form
Sports Camp:	* required
Participant First Name:	*
Participant Last Name:	*
Parent/Guardian Name:	*
Address:	*
City:	*
State:	*
Zip Code:	*
Phone:	*
Email Address:	*
Age:	*
Date of Birth:	*
Sex:	Male Female *
Disabilities:	*
Seizures:	Yes No *
Medications:	*
Wheelchair:	Manual Power
	I would like to participate in the Paralympic Breakout Session for ambulatory athletes with physical challenges such as Cerebral Palsy, Traumatic Brain Injury or Stroke.
Emergency Contact:	*
Emergency Contact Phone:	*

Sports Camp Participant Waiver of Liability
IIn consideration of my child (participant) being permitted to participate in the White Sox Sports Camp offered by the National Sports Center for the Disabled and The Chicago White Sox, on behalf of my child, myself, and anyone who obtains rights from my child or me, I hereby voluntarily waive, fully release and discharge any of the above mentioned agencies and entities, their directors, officers, employees, agents, insurers, various sponsors and paid and non-paid volunteers from liability for injury, illness, death, damage or loss to participant or participant's property arising out of or in any way related to Participant's activities at the Chicago White Sox Sports Camp. I understand that the staff/volunteers of this camp are not allowed to administer medication or provide personal care such as feeding, toileting, and/or dressing. Anyone needing this type of assistance must make their own arrangements. I have read this form and understand its content and request registration for my child.
Agree:	Yes No *
Photo Release

I grant permission for Participant's picture to be used in publicity or brochures related to this event.
Agree:	Yes No *
Participant Name:	*
Date:	*
By checking this box, this will act as your digital signature.	I agree
Please print this page out and bring it to the camp with you.

P.O. Box 1290, Winter Park, Colorado 80482 USA ph: 970.726.1540 or 303.316.1540 fx: 970.726.4112
Denver Office: 1801 Bryant St, Ste 1500, Denver, CO 80204 ph: 303.293.5711 fx: 303.293.5448 Email: info@nscd.org
KC Office: 4600 63rd St, Kansas City, MO 64130 ph: 816.513.7571 Email: infokc@nscd.org

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