Access Leisure Registration Forms
_______________________________________________________
WAVE Camp Application Form
Applicant’s Name _______________________________
Age______ Male [ ] Female [ ]
Address_______________________________________
City _____________________ State___ Zip_________
Home Phone_________________ Cell_______________
Work Phone____________________________________
Parent/Guardian_________________________________
Athlete’s Disability_______________________________
______________________________________________
Requested Roommate____________________________
[ ] Session 1 Mon. 7/7 - Fri. 7/11
(For campers age 10-15 years old)
[ ] Session 2 Sun. 7/13 - Thurs. 7/17
(For campers age 16-25 years old)
T-Shirt Sizes:
[ ]Youth S [ ]Youth M [ ]Youth L
[ ]Adult S [ ]Adult M [ ]Adult L [ ]Adult XL [ ]Adult XXL
Please Make Check Payable to: W.A.V.E. Camp
[ ] Full Payment $1150
(This includes camp cost AND $100 mandatory deposit)
[ ] Registration deposit enclosed $100 - Balance due by July 1
[ ] Scholarship Requested - Please submit a letter of request
[ ] Regional Center Client -
Call your Regional Center Service Coordinator
to determineeligibility for WAVE Camp.
Name of Regional Center: ____________________
Service Coordinator’s Name: __________________
Service Coordinator’s Phone: __________________
[ ] Regional Center Client -NOTE: if you are regional center client,
you must still send in a $100 mandatory deposit which will be
refunded to after camper attends camp.
Please mail form and payment to:
W.A.V.E. Camp
6005 Folsom Blvd.
Sacramento,CA 95819
Tele: 808-6017 Fax: 808-6074
Sponsored by the City of Sacramento Department of Parks and Recreation, Access Leisure in partnership with CSUS and DSUSA.
___________________________________________________________
2008 BASEBALL FOR ALL REGISTRATION
Athlete’s Name:_____________________________
Age:______ Birthday: ___/___/___
Parent(s)/ Guardian(s) Name(s):__________________________________________
Address:__________________________________________________
City: _______________________ State: _______ Zip:___________
Phone: ________________ Cell: ______________________
E-mail Address:__________________________________________
Type of Mobility:
(If athlete will be using more than one device,please bring all devicesThat will be used):
Wheelchair: [ ] Manual [ ] Power - voltage:_____Other Devices:[ ] Braces/Crutches
[ ] Walkers [ ]
Uses No Devices
Diagnosis and Disability:
_________________________________________________
T-Shirt Size (For ball player ONLY):
Youth Sizes: [ ] Small [ ] Medium [ ] Large
Adult Sizes: [ ] Small [ ] Medium [ ] Large [ ]XL [ ]XXL
[ ] Yes, I will attend the “Baseball for All Clinic” on Saturday, May 3, 10am to 1pm
[ ] Yes, I will attend the River Cats game on Thursday, May 15, at 7pm
Liability Release: The undersigned, in consideration of the acceptance of this entry, I hereby waive, release and indemnify the City of Sacramento, Access Leisure, River Cats Ball Club, its owners, sponsors, staff, volunteers, and agent from any and all liability for injuries and/or expenses incurred by myself at the Baseball for All Free Skills Clinic. In case of accident arising out of the said activity, medical assistance may be administered to the registrant of this activity. I understand the medical costs incurred by the participant are the responsibility of the participant/parent/guardians.
Media Release: I specifically grant permission to Baseball For All and the City of Sacramento, Access Leisure to use my likeness, voice and words in television, radio, newspapers, films, magazines, and media of any form not heretofore described to further the aims of Baseball For All and River Cats Independence Field.
__________________________________________________________________
Signature of athlete, or guardian if under 18 yrs/ old Date Signed
Return to: Steve Hornsey, 6005 Folsom Blvd., Sacramento, CA 95819.
__________________________________________________________________
Registration for Access Leisure Ink Quarterly Newsletter
Starting January 2009, a yearly $10.00 service fee for the Access Leisure Ink quarterly newsletter will be charged to people who are requesting to receive the newsletter through the mail. People who do not respond by December 3rd, 2008 will be removed from the Access Leisure mailing list.
Please complete and return Access Leisure Ink
Mailing List Questionnaire Form
Name: _______________________________________________
Phone: _____________________________
Mailing Address: _____________________________________________
City: ____________________ Zip ________________
Please check one box below:
[ ] Please keep me on the US Mailing list.
I have included a check of $10.00 for fees.Make checks payable to: City of Sacramento
Mail to: Access Leisure INK Newsletter Fee, 6005 Folsom Blvd, Sacramento, CA. 95819
[ ] Please remove me from the Mailing List.
** To receive the quarterly newsletter via email Steve Hornsey at shornsey@cityofsacramento.org.
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