Home
New at Baseball Plus
Summer Camp
About Baseball Plus
Epstein Hitting System
Private Instruction
Baseball Plus Nine
Batting Cages
Parties
Pro Shop
Our Philosophy
FAQ
Directions
Hours of Operation
Contact Us
About Our Staff
Baseball Plus 2008 Summer Camp Registration Form
Please complete this form in full for each child you are registering

Player's First Name * 
Player's Last Name: * 

Select Camp Session(s) *

Player's Street Address * 
City * 
State * 
Zip Code * 
Player's Date of Birth *    MM/DD/YYYY
Phone Number *    (XXX) XXX-XXXX
Email Address * 
School in Sept 2008 * 
Grade in School - Sept 2008 * 
Father's Name (First, Last) * 
Father's Work Phone *    (XXX) XXX-XXXX
Father's Cell Phone *    (XXX) XXX-XXXX
Mother's Name (First, Last) * 
Mother's Work Phone *    (XXX) XXX-XXXX
Mother's Cell Phone *    (XXX) XXX-XXXX
Emergency Contact Name * 
Emergency Contact Phone *    (XXX) XXX-XXXX
Pediatrician's Name * 
Pediatrician;s Phone *    (XXX) XXX-XXXX
Dentist's Name * 
Dentist's Phone: *   (XXX) XXX-XXXX
 
Medical Information:

Please describe any pertinent medical conditions that the Baseball Plus Staff should be aware of such as: (ASTHMA, ALLERGIES, BEE STINGS, MEDICATION, OTHER)
Medical Information 
 
Consent Agreement:

I the parent of the above named child, hereby give my approval to participate in any Joe Espinosa's Baseball Plus activities including transportation.I know that participation in sports may result in serious injuries and protective equipment does not prevent all injuries to players and do hereby waive, release, indemnify and agree to hold harmless Joe Espinosa's Baseball Plus, Ridgefield Little League, American Legion Baseball and Wooster School, the organizers, supervisors and participants for all injury to my child whether the result of negligence or for any other cause.
Consent Agreement *
 
Bus Permission:

As part of your child's participation in Joe Espinosa’s Summer Baseball Camp, it may be necessary for Basebball Plus to provide bus transportation for your child (e.g. in the event of rain during a camp day). Please indicate your permission to use bus transportation for this purpose.
Bus Consent *
 
Medical Consent:

I, the parent of the above named child hereby give consent for the emergency medical care prescribed by a duly licensed physician, dentist, or emergency medical technician. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.
Medical Consent *
 
Media Release:

Photos or video may be taken of individuals participating in our various programs. Some may be used for promotion and marketing purposes.
Media Release *

 
Payment:

We Accept Visa and Mastercard. Before processing your credit card, we will apply earned discounts for siblings and/or multiple sessions.
Credit Card Type: * 
  We Accept Visa or Mastercard

Credit Card Number: *   no spaces
Expiration Month: * 
Expiration Year: * 
Credit Card Validation *   Your 3 or 4 digit credit card validation number

Name on Credit Card * 


Please review all of your responses and then hit the submit button below.
Thank you for registering for Summer Camp at Joe Espinosa's Baseball Plus.



siteseal.gif

Your data is encrypted and securely transmitted.
 
< Prev
Copyright 2008 Joe Espinosa's Baseball Plus. All Rights Reserved.