Emergency Contact Camper Information Parents _________________ Name ______________________ Home Phone ________________ Address___________________________ Work Phone ________________ _________________________________ Cell Phone _________________ Email_____________________ School____________ Roommate Request: In case of EMERGENCY _________________________________ Contact _________________ Relationship Address _________________ Players Position _____________ T-Shirt Size _______ Age:_______ Phone Numbers (Home & Cell) _______________________________ DOB: _________ Health Insurance Carrier: Height ______ ________________________ Weight ______ Policy#: ____________________ Phone: _____________________ I have carefully read the enclosed information For further information: and agree to the conditions stated herein. [email protected] _____________________ (610) 780 - 0735 (Itinerary will be sent via e-mail) Kutztown Elite 7’s Rugby Camp (14-19 yrs old) June 25-28 Check-in: June 25 at 1:00pm SHARP! Check-out: June 28 at 1:00pm SHARP! CAMP FEES _ $375.00 Overnight Camper includes four days of instruction, housing, breakfast, lunch and dinner. _ $300.00 Overnight TEAM rate (min 7 players) includes four days of instruction, housing, breakfast, lunch, dinner. _ $275.00 Commuter rate includes four days of instruction, breakfast, lunch and dinner EARLY BIRD SPECIAL BY JUNE 1 - 10% OFF INDIVIDUAL CAMPER Payment information: Make checks payable to Larry Chester and mail to 14996 Kutztown Road, Kutztown, PA 19530 A ABOUT THE CAMP Kutztown University is a rural 325 acre campus centrally located between Allentown and Reading in Pennsylvania. The air conditioned dorms, dining hall and fields are located within 250-yard radius. Indoor and outdoor facilities Air Conditioned Dormitory Indoor Swimming Pool T-shirts and Awards Cafeteria Style Meals Strength and Conditioning All players will be video taped and photographed Instructional Film Sessions 7’s Games!!!! Dr. Gregg Jones Head Coach at Kutztown University 29 years, over 600 wins at KU Head Coach Eastern PA Select Side Head Coach Mid-Atlantic Collegiate Select Head Coach Eastern USA Collegiate Select 19 USA Collegiate All-Americans 6 USA Junior Eagle U-20 World Cup Team Members 1 USA Eagle 7’s Team Member 1 USA Eagle 15’s Team Member Larry Chester Assist. Coach at Kutztown University (Defensive Coordinator) 1 9 years Coaching Experience: Rugby, Football and Track/Field Head Strength / Conditioning Coach 19years OTHER COACHES….. PAST AND PRESENT MEMBERS OF KUTZTOWN UNIVERSITY MEN’S RUGBY
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