How To Sign Up
Please send everything in by July 26th
2004 Summer Softball Camp
Fill out and mail now with full payment. Applications will be processed on a first-come, first-served basis.
PLAYER INFORMATION
Name: ________________________________
*No refunds after the start of camp
YOU MUST FILL THIS OUT!
MEDICAL INFORMATION
Player Name: ________________________________
Information concerning health:
I give my daughter permission to participate in the 2004 URASTAR Softball Summer Camp at Bowie High School. I understand she will participate at her own risk. I also give permission for an adult representative of URASTAR to authorize medical treatment in the case of an emergency if unable to contact me.
Print Name: ___________________________
Signed: _____________________________
Date: ____________________
SPACE LIMIT- RESERVE YOUR SPACE TODAY
Address: _____________________________
City/State/Zip: ____________________________
Telephone: __________________________
Age: _____ School: ________________________
E-mail: ______________________________
*cancellation notices will be sent via e-mail*
Please check here as to whether you wish to receive information on our camps/clinics via e-mail:
Yes ______ No ______
COST $175 per player
Make checks payable to: Aimee Mason
Mail to:1409 Jewell Rd.
Dunkirk, MD 20754
**$25 returned check fee
In case of an emergency, notify:
Name: _________________________________
Relationship: ____________________
Daytime Phone: ____________________
Night Phone: ___________________
Chronic illnesses or allergies:
_________________________________________
Medications taken regularly:
_________________________________________
Health insurance company:
____________________________________
Group No.: _________________________
Policy No.: ________________________
