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:         

PureAthleticism 3911 W. Bertona St. Seattle, WA 98199