PATTON PANTHERS

							PATTON PANTHERS
3rd ANNUAL
BASEBALL CAMP

JULY 13 – 15
Registration: 9:00am-9:30am, Day 1
Camp: 9:30am-12:30pm
Cost: $40

NAME:_________________________________________________________________

ADDRESS:_____________________________________________________________

CITY/STATE:__________________________                                            PHONE:______________________

GRADE (entering):______ T-SHIRT SIZE: YS - YM - YL - S - M - L - XL - XXL

PARENT NAME(S):______________________________________________________

                          EMERGENCY CONTACT (if different from above)

NAME:________________________________                                            PHONE:______________________


                                             WAIVER AND RELEASE FORM
Please read and complete the following. This waiver ad release form is to be returned alone with your application and camp payment.
My child has permission to attend the “Junior Panther Baseball Camp.” I certify that within the past year he/she has had a physical
examination, and that he/she is physically able to participate in all camp activities. In the event of an illness/injury, I hereby give my
consent for medical treatment to be administered. I also give permission to any physician that may need to become involved in the
right to hospitalize, secure proper treatment and order injections, anesthesia, or surgery. I will be responsible for any medical or other
charges in connection with my child’s attendance at camp. My child is covered by the following Insurance Company:

                                              _________________________ ____________________________
                                              Name of Insurance Company Insurance Company Policy Number

Are there any restrictions on the camper’s participation?    YES____             NO____ Please explain if “YES”

Applying for acceptance to the “Junior Panther Baseball Camp,” I intending to be legally bound, hereby for myself, my heirs,
executors and administrators, waive and release any and all rights and claims for damages I may have against the “Junior Panther
Baseball Camp” or its representatives, for any and all damages which may be sustained by me in association with this camp, and
which may arise out of my traveling to, participating in, or returning from the camp.

_________________________________________                            ___________________________________
Signature of Parent/Guardian                                         Date