2009 WINTER APPLICATION -- EMORY BASEBALL CAMP
Registration Form & Parental Consent Form
Please print this page, fill out both the Registration Form and Parental Consent Form, and return as soon as possible with your check made payable to:

Michael Twardoski / Emory Baseball Camps
Woodruff Physical Education Center
Atlanta, GA 30322
Mike (404) 727-0877 or Tina (770) 609-2679

Name ____________________________________ Age: _______ Birthdate: __________

Address ________________________________________________________________

City, State, Zip ___________________________________________________________

Parent(s) ________________________________________________________________

Home Phone _________________________ Work Phone _________________________

Parent E-mail Address ____________________________________________________

How did you hear about our camp? ___________________________________________

Please inform us of any Medical Conditions: ___________________________________

CHECK (  X  ) SESSION ATTENDING:

____ December 26th-27th, 10:00 AM - 3:00 PM, $75

____ After Care. 3:00 PM - 5:00 PM, $10 per day

CONSENT FORM
I hereby permit my child to participate in the Baseball Camp offered by Mike Twardoski and Emory University, and by the execution of this release, I acknowledge and agree that all requirements, directions, supervision, and standards set by the directors of this program shall be established for his/her benefit. I hereby voluntarily assume all risk of accident or injury to my child which may arise out of his/her participation in this program, hereby intending to release Mike Twardoski and personnel associated with this program from liability that may result from his/her participation. In addition, I hereby give my permission for emergency medical treatment in the event I cannot be reached.

Print Camper's Name _________________________________________________________________________

Parent/Guardian Signature (with Date) __________________________________________________________

Emergency Phone ___________________________________________________________________________

Insurance Carrier AND Policy Number _________________________________________________________

NOTE: Camp sessions tend to fill up quickly. To ensure registration, please complete Application AND Consent Form and return, along with your check made payable to:  Mike Twardoski / Emory Baseball Camp