Please print and fill in this form. Send payment of $75 and form to:
Skip Palmer:
Softball the Titan Way Softball Camp
4663 Middle Road
Allison Park, PA 15101
Questions call: 412-486-2416
Registration Form for Softball Camp 2011
NAME ____________________________
PHONE # __________________________
CELL # ____________________________
EMAIL ADDRESS: ________________________________
ADDRESS _________________________________________________________________
CITY _____________________ STATE ____________ ZIP _______________
SCHOOL ____________________________________
AGE _________ (IN SEPT.)
EMERGENCY CONTACT NAME AND NUMBER: _____________________________________________________
ADULT T-SHIRT SIZE (CIRCLE ONE) S - M - L - XL
Camp Dates: June 20th - June 23rd, 2011 for 8-11 year olds
Rain Date June 24th
Camp Dates: June 27th - June 30th, 2011 for 12-15 year olds
Rain Date July 1st
RELEASE FORM: Applicant agrees that Titan Softball Camp, its associates, instructors, licensees, proprietors, employees, agents and/or representatives will not be held responsible for any accidents or loss, however caused, and agrees to release the Titan Softball Camp, its associates, instructors, licensees, proprietors, employees, agents and/or representatives. This release shall be binding on the players, heirs, executors and/or administrators.
SIGNATURE OF PARENT OR GUARDIAN (In Ink)
X___________________________________________
DATE ______________
**Please attach a note explaining any medical conditions and/or physical limitations that we need to be aware of.
**Make check payable to TITAN SOFTBALL CAMP.
IF MAILING FORM IN SEND TO:
TITAN SOFTBALL CAMP
4663 MIDDLE ROAD
ALLISON PARK, PA 15101
