2008 PUREATHLETICISM REGISTRATION FORM
Participant’s Name______________________________Age____ Amount Enclosed______
Referred by:____________________________
Address___________________________________________________________________
Zip code______________ Week #__________
Parent/Guardian(s)__________________________________________________________
Home phone____________________________
Work phone_____________________________ Other phone________________________
E-mail____________________________________________________________________
Emergency contact_________________________________________________________
Emergency phone__________________________________________________________
I hereby authorize the staff of PureAthleticism Baseball Camp to act for me according to their best judgment in any emergency requiring medical attention and I hereby waive and release the camp from any and all liability for injuries or illnesses incurred while at camp.
Parent/Guardian signature______________________________________Date__________
Please make checks payable to: