Softball Camp AWS
2016 LBI. Christmas Baseball/Softball Camp Held by Marc LaMacchia and Staff Registration Form Paid____
Check _____
Cash_____
December 19-22 ______
Camper’s Age___ Camper’s Grade ___ Baseball/Softball Camp____ Advanced Camp_____ Camper’s Name_________________________________________________________ Address_______________________________________________________________ City_________________________
State_______________
Zip_______________
Parent’s Name__________________________________________________________ *Priority Cell Phone #__________________________________________________________ *E-mail Address__________________________________________________________ *Emergency Contact_______________________________________________________ Last Team played on _______________________
Medical Information All campers must have their own medical coverage. Campers will not be allowed to play unless the following information is submitted. This form must be signed by the parent or guardian of the camper.
Camper’s Insurance Co.______________________________________________________ Policy #___________________________________________________________________ Subscriber’s Name__________________________________________________________ Insurance Phone #__________________________________________________________ Medical Treatment Authorization I/we the undersigned, for ourselves, our heirs, executors and administrators, waive, release and forever discharge the LBI. Baseball Camp and its staff from all rights and claims for damage, injuries, or loss of personal property which may be sustained or occur during participation in camp activities or while at camp.
*Signature_______________________________________________
*Date__________________________
Check _____
Cash_____
December 19-22 ______
Camper’s Age___ Camper’s Grade ___ Baseball/Softball Camp____ Advanced Camp_____ Camper’s Name_________________________________________________________ Address_______________________________________________________________ City_________________________
State_______________
Zip_______________
Parent’s Name__________________________________________________________ *Priority Cell Phone #__________________________________________________________ *E-mail Address__________________________________________________________ *Emergency Contact_______________________________________________________ Last Team played on _______________________
Medical Information All campers must have their own medical coverage. Campers will not be allowed to play unless the following information is submitted. This form must be signed by the parent or guardian of the camper.
Camper’s Insurance Co.______________________________________________________ Policy #___________________________________________________________________ Subscriber’s Name__________________________________________________________ Insurance Phone #__________________________________________________________ Medical Treatment Authorization I/we the undersigned, for ourselves, our heirs, executors and administrators, waive, release and forever discharge the LBI. Baseball Camp and its staff from all rights and claims for damage, injuries, or loss of personal property which may be sustained or occur during participation in camp activities or while at camp.
*Signature_______________________________________________
*Date__________________________
