North Fort Myers Babe Ruth-Cal Ripken Baseball League
North Fort Myers Babe Ruth-Cal Ripken Baseball League HELL WEEK 2014 Please Print Clearly Player Information Name DOB
Age
Shirt Size
Allergies or Medical Conditions
Other Emergency Contact Phone No and Relationship to Player
Parent/Guardian Information Name Mailing Address Street Address (if different) Home Phone
Cell Phone
Email Address Relationship to Player(s)
Addiitonal Parent/Guardian Information Name Mailing Address Street Address (if different) Home Phone
Cell Phone
Email Address Relationship to Player(s)
* Cost of this Camp is $75. * Refund Policy. In the event we do nt have enough interest in this program, all monies will be promptly refunded. * Returned checks will be charged a $20 Administrative Fee. * Credit and Debit cards accepted.
Print Form
CONSENT FOR TREATMENT Each Player must complete and have signed Name of Player___________________________________________________ Player’s Age____________ Home Address______________________________________ City___________________ State________ Family Physician___________________________________________ Phone_________________________ List of Any Allergies______________________________________________________________________ Required Medication______________________________________________________________________ Name of League___________________________________________________________________________ League Accident Insurance Company_______________________________________________________ League Accident Insurance Policy No._______________________________________________________ In case of an accident or illness, I hereby authorize a representative of Babe Ruth League, Inc. to use his/her judgment in obtaining immediate Medical Care. DATE_______________ SIGNED____________________________________________________________________ (Parent or Guardian) Daytime Phone ( )_____________________________ Home Phone ( )________________________________ Cell Phone (
)___________________________ Parents Health Ins. Co.___________________________________ Policy #_______________________________________________
(Parents will be notified in case of serious illness or injury as quickly as they can be reached, but this will make immediate treatment possible.
Age
Shirt Size
Allergies or Medical Conditions
Other Emergency Contact Phone No and Relationship to Player
Parent/Guardian Information Name Mailing Address Street Address (if different) Home Phone
Cell Phone
Email Address Relationship to Player(s)
Addiitonal Parent/Guardian Information Name Mailing Address Street Address (if different) Home Phone
Cell Phone
Email Address Relationship to Player(s)
* Cost of this Camp is $75. * Refund Policy. In the event we do nt have enough interest in this program, all monies will be promptly refunded. * Returned checks will be charged a $20 Administrative Fee. * Credit and Debit cards accepted.
Print Form
CONSENT FOR TREATMENT Each Player must complete and have signed Name of Player___________________________________________________ Player’s Age____________ Home Address______________________________________ City___________________ State________ Family Physician___________________________________________ Phone_________________________ List of Any Allergies______________________________________________________________________ Required Medication______________________________________________________________________ Name of League___________________________________________________________________________ League Accident Insurance Company_______________________________________________________ League Accident Insurance Policy No._______________________________________________________ In case of an accident or illness, I hereby authorize a representative of Babe Ruth League, Inc. to use his/her judgment in obtaining immediate Medical Care. DATE_______________ SIGNED____________________________________________________________________ (Parent or Guardian) Daytime Phone ( )_____________________________ Home Phone ( )________________________________ Cell Phone (
)___________________________ Parents Health Ins. Co.___________________________________ Policy #_______________________________________________
(Parents will be notified in case of serious illness or injury as quickly as they can be reached, but this will make immediate treatment possible.
