Camp Selection

Please make a camp selection.

Day Camper - Fee includes T-Shirt, lunch, and insurance: $275.00
Overnight Camper - Fee includes T-Shirt, meals, housing, and insurance: $325.00


Choose Your Payment Option

Pay for my child to attend camp.
Pay for another child to attend camp (Gift Certificate).

Billing Information

Name as it appears on credit card


First Name
Last Name

Billing Address


Address

Address Line 2

City
Billing State

Zip Code
Country

Telephone Numbers


Home Number

Work Number

Cell Number

E-Mail Address

Credit Card Information


Type:   Visa     Master Card     American Express     Discover   


Credit Card Number
 / 
Expiration (mm/yyyy)
CVV Code

Parent / Guardian Information

Check this box if the following information and your billing information are the same.

Name


First Name
Last Name

Mailing Address


Address

Address Line 2

City
Mailing State

Zip Code
Country

Telephone Numbers


Home Number

Work Number

Cell Number

E-Mail Address

Camper Information

Camper's Name


First Name
Last Name

Camper's Age

Camper's Gender

Male Female

Camper's Birthday

 /  / 

Camper's Email

Roommate Preference

Emergency Contact Information

Name of Parent/Guardian


First Name
Last Name

Relationship to Camper


Contact Phone Number

Cell Phone Number

Contact Email

Medical Information

Emergency Contact


Contact Name

Contact Number

Health Insurance Provider for Camper

Policy Name (Whose name is the policy filed under?)

Date of Last Tetanus Shot

Allergies, Medications, or Other Conditions (please list anything you'd like us to be aware of in case medical treatment becomes necessary)

Medical Authorization

By clicking on the box to the left and entering my name and today's date into the fields below, I hereby authorize camp staff to act for me in any emergency and hereby waive and release staff members and/or associate staff from any and all liability for any and all injuries while participating in any instruction program from the date forth. Medical insurance shall be my responsibility (parents/guardians) unless stated in writing otherwise.

Full Name
Date

Photographic Release

By clicking on the box to the left and entering my name and today;s date into the fields below, I fully understand that the staff reserves the right to use photographs of ball players for publicity and advertising purposes.

Full Name
Date