TRIPLE THREAT SOFTBALL CAMP
REGISTRATION FORM
2012
PLEASE PRINT ALL INFORMATION
Camp Location: Blytheville Sportsplex Camp Date: September 15-16
Times of the Camp:
Name: ___________________________________________ DOB: _______________
Email Address: _______________________________________________________________________
Address: ____________________________________________________________________________
City: _____________________________ State: ____________ Zip: __________________________
Home Phone (____) ___________________________________
Cell Phone (____) ____________________________________
Parent/Guardian’s Name: _______________________________________
Emergency Phone: (____) ______________________________________
ENTRY FEE $200.00 (Deadline August 27, 2012)
Camper Information Required:
T-Shirt Size: ALL ADULT SIZES
SMALL ____ MEDIUM ____ LARGE ____ XLARGE ____
Primary Position (circle one): PITCHER CATCHER INFIELD OUTFIELD
Secondary Position (circle one): PITCHER CATCHER INFIELD OUTFIELD
All Campers are required to have their oven medical insurance and must show proof of that insurance on the first day of registration.
ANY CANCELLATIONS TWO WEEKS PRIOR TO THE CAMP DATE WILL BE NON-REFUNDABLE
CONDITIONS OF APPLICATION:
Guardian must read and sign below:
1. I understand that this camp is operated by the individual coaches named. Accordingly, I agree to release and hold harmless the individual coaches, Blytheville Baseball Softball Boosters, its agent, and other staff, while acting in their capacities as such, from any and all claims of liability which may arise in any manner or form from my child’s participation in this camp.
2. I hereby authorize the Triple Threat Softball staff to act for me, according to their best judgment, in any medical emergency. As parte/guardian of aforementioned camper, I take full responsibility for payment of injuries that may occur during the Triple Threat Softball Camp and I hereby waive and release said persons from any liability of illness/injury incurred while attending camp.
Signature of Parent/Guardian _______________________________________
REGISTRATION REQUIREMENTS --- PLEASE MAKE SURE THAT YOU HAVE COMPLETED THE FOLLOWING CHECKLIST BEFORE SENDING IN YOUR APPLICATION.
______COMPLETE APPLICATION FORM
______ ENCLOSE CHECK AND MAIL TO:
BBSB
PO BOX 1741
BLYTHEVILLE, AR 72316
CONTACT: JOHN WEBB (870) 740-1298
COACHES: MONICA ABBOTT
KATELYN LOWE
KELLEY CRUTCHMAN
FOR MORE INFORMATION: