Name: ________________________________ Age: ________
Address: __________________________________________
City: ________________________ State: ____ Zip: _______
Phone: _________________ E-Mail: ___________________
Parent/Guardian Name(s): ____________________________
Parent/Guardian Work Phone: _________________________
Ht.: __________ Wt.: __________ Date of Birth: __________
Grade Entering Sept. '00: _____ School: ________________
Have you ever attended a CBL Camp before? ____________
Throws: R___ L___ Bats: R___ L___ Both ___
______ Attending Session 1: $125.00
______ Attending Session 2: $90.00
______ Attending Both Sessions: $200.00
Medical Concerns: ___________________________________
Emergency Contact
Name: ________________________ Phone: ______________
WAIVER
I certify that my child is in good physical condition and can partake in the daily schedule of events. In case of emergency I grant permission for my child to be given treatment by accredited camp personnel and/or a local hospital. I hereby waive all claims for injury or loss to my child or property resulting from my child's participation in any activity connected with the camp. I fully understand that the activities covered by this waives, exerciser agreement include, but are not limited to, practice, drills, exercise, and actual games, conducted by any officer, agent or employee of the Collegiate Baseball League or the Washingtonville P.A.L.
Parent/Guardian Name: __________________________________________
Parent/Guardian Signature: _______________________________________
Date: ____________________
*** Medical Insurance Provided ***
Sessions run from 9:00 a.m. until 1:00 p.m. daily.
Camp will be conducted on a punctual basis so please coordinate your child's transportation accordingly!
IMPORTANT MESSAGE: The CBL Camp will not tolerate any student who disrupts the camp, destroys property or fails to adhere to camp rules. Parent(s) of any such student will be called to come and pick up student and remove them from the premises. There will be no refund or credit given.
No Refunds
Use separate forms for each camper. Mail along with the appropriate fee, payable to CBL, to:
CBL
15 North Street
Washingtonville, NY 10992
Please call (845) 497-8355 if you have any questions.
