Trosky Baseball
Youth Summer Camp
Registration
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Player First Name:
*
Player Last name:
*
Camp Session:
select
Camp I (June 13-17) - Full Day
Camp I (June 13-17) - Half Day
Camp II (July 18-22) - Full Day
Camp II (July 18-22) - Half Day
Day Rate Camper
Player Positions:
primary
1B
2B
SS
3B
OF
C
P
U
secondary
1B
2B
SS
3B
OF
C
P
U
Allergies:
Medical Conditions:
*
Age of Participant:
*
Date of Birth:
mo
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
*
day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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yr
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
League Played In:
Years in Organized Baseball?
select one
None
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Day Rate Campers
Number of Days Attending:
Half Day - $35
Full Day - $60
Please e-mail
rmoore@troskybaseball.com
with the specific camp dates your child plans to attend after completing registration.
Guardian Information
*
Parent/Guardian Name:
Relationship:
select relationship
Mother
Father
Step-Mother
Step-Father
Grandmother
Other Legal Guardian
*
Home Phone:
Cell Phone:
Work Phone:
*
E-mail Address:
*
Address:
*
City:
*
State:
select state
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
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Zip:
*
Insurance Carrier:
*
Policy No:
*
Emergency Contact:
*
Emergency Phone:
How did you hear about this event?
select one
E-mail
Friend
Website
Newspaper
Other
Are you interested in private lessons for your son/daughter?
Yes
No
Would you consider advertising with Trosky Baseball?
Yes
No
Would you consider donating to our youth scholarship fund?
Yes
No
*
By checking yes and submitting this electronic registration form, I give permission for my (son/daughter) to attend any activity held by Trosky Baseball. I hold harmless Trosky Baseball, its owners, employees, spondsors, sites, school districts, and coaches. The consenting parties understand and acknowledge that serious accidents any occur during these activities, and that the risk of personal injury as a consequence thereof can be significant, including the potential for paralysis and even death. Knowing the risk of participating in these activities, the consenting parties agree to assume these risks. The release of Liability and Assumption of risk shall be binding on each of the consenting parties' respective heirs, successors and assigns. I understand it's necessary to have primary health insurance coverage on my child. I hereby give consent for the performance of such diagnosis, medical and/or surgical treatment on my son or daughter as may be deemed medically necessary in order to assure the safety of my child. All efforts will be made to contact me before procedures are performed.
Yes, I Consent
*
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*
Indicates Response Required