Camp Selection

Please make a camp selection. The cost of FULL DAY CAMP is $280.48 ($260.00 + $20.48 registration fee). You may also choose to attend a MINI CAMP for a total cost of $172.60 ($160.00 + $12.60 registration fee)

June 7 - 11, 2010 Full Day
June 7 - 11, 2010 Mini Camp

June 21 - 25, 2010
June 21 - 25, 2010 Mini Camp

July 12 - 16, 2010
July 12 - 16, 2010 Mini Camp

July 19 - 23, 2010
July 19 - 23, 2010 Mini Camp

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

Billing Address


Address

Address Line 2

City
Billing 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 Birthday

 /  / 

Previous Position

Camper's Shirt Size

Parental Consent and Waiver/Release

I certify the my child is medically cleared to attend camp and give permission for medical treamtment for injuries or illness during camp/clinic. A professional trainer will be available.

Emergency Contact


Name
Phone
Name
Phone

Allergies


Allergic Reactions (drugs, food, asthma, bee stings, etc? List here or indicate None Known)

Medications


Medications (Please list any medications camper is taking at this time or indicate None)

Health Insurance Information


Health Insurance Carrier
Policy Number
Insurance Agent
I do hereby waive and release Furman University and the respective staff, employees, successors, and assigns, of and from any and all rights and claims for damage resulting from injury of my person or property, which may be sustained or suffered by me in connection with my association with or participation in, or arising out of my traveling to or from the Summer Baseball Camp at Furman University. I, the parent/guardian, agree to the above waiver and release and we join therein.

By clicking on the box to the left and entering my name and today’s date into the fields below, I hereby agree to the terms and conditions set forth above.

Full Name
Date