General Information Softball Information Insurance Information ...
General Information Camper’s Name_________________________________________________ Address_______________________________________________________ Age______ Grad Yr._______School_________________________________ Travel Summer Team____________________________________________ Parent or Guardians Name________________________________________ Primary Phone #_______________ Secondary Phone__________________ Email Address__________________________________________________
Softball Information Primary Position_______________Secondary Position(s)________________
Insurance Information Medical Insurance Company _______________________________________ Policy Holder’s Name_____________________________________________ Insurance Company Address_______________________________________ Insurance Company Phone #_______________________________________ Policy Number ____________________ Group Number_________________
Health Information Current Medications__________________________________________________ Allergies____________________________________________________________ Chronic Medical Conditions____________________________________________ Pre-Existing Injuries__________________________________________________
PLEASE CHECK WHICH SESSION YOU WISH TO ATTEND: September 10th, 2017 Pitching Catching 9:00am- 10:30am Hitting/Slapping 11:00am – 1:00pm Defense – Infield or Outfield 2:00pm-3:30pm Game Simulation Showcase 4:00pm-6:00pm Total Softball Sessions:__________
Total Amount:________
Ages: 12-18yrs. Cost: Cost: $65 single session, $120 for 2 sessions, $150 for 3 sessions, $180 for 4 sessions
Mail Registration Forms Along with Payment To: Mercer University Softball, Attn: Stephanie DeFeo 1400 Coleman Avenue, Macon, GA 31207 (Please make checks payable to Stephanie DeFeo) *Mercer Softball Camps are open to any and all entrants, limited only by age, number, gender, and grade.
Softball Information Primary Position_______________Secondary Position(s)________________
Insurance Information Medical Insurance Company _______________________________________ Policy Holder’s Name_____________________________________________ Insurance Company Address_______________________________________ Insurance Company Phone #_______________________________________ Policy Number ____________________ Group Number_________________
Health Information Current Medications__________________________________________________ Allergies____________________________________________________________ Chronic Medical Conditions____________________________________________ Pre-Existing Injuries__________________________________________________
PLEASE CHECK WHICH SESSION YOU WISH TO ATTEND: September 10th, 2017 Pitching Catching 9:00am- 10:30am Hitting/Slapping 11:00am – 1:00pm Defense – Infield or Outfield 2:00pm-3:30pm Game Simulation Showcase 4:00pm-6:00pm Total Softball Sessions:__________
Total Amount:________
Ages: 12-18yrs. Cost: Cost: $65 single session, $120 for 2 sessions, $150 for 3 sessions, $180 for 4 sessions
Mail Registration Forms Along with Payment To: Mercer University Softball, Attn: Stephanie DeFeo 1400 Coleman Avenue, Macon, GA 31207 (Please make checks payable to Stephanie DeFeo) *Mercer Softball Camps are open to any and all entrants, limited only by age, number, gender, and grade.
