Student-Athlete Information

Player Name

First Name

Last Name

Team/Age Group

Player DOB

MM

DD

YYYY

Projected Graduation Year

Additional Information

Camp Dates I can attend (Select one or more)

Nov 20th (Monday) - 6pm -8pm - Defense

Nov 21st (Tuesday) 6pm - 8pm - Pitching & Catching

Nov 22nd (Wednesday) 6pm - 8pm - Defense

Parent Contact Information

Primary Email Address

Primary Phone Number

(###)

###

####

Secondary Email Address

Secondary Phone Number

(###)

###

####

Payment Information

Credit Card information is required for deposit.

Name on Card

First Name

Last Name

Credit Card #

Expiration Date

CVV Code

3-4 Digit Number on the back of your card

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

PARENT/GUARDIAN AGREEMENT

I/WE HAVE READ THE BELOW AGREEMENT AND UNDERSTAND THAT I/WE GIVE UP CERTAIN RIGHTS BY VOLUNTARILY SIGNING THIS FORM. BY CHECKING THIS BOX, I AM ALSO CONFIRMING THE USE OF THE PROVIDING BILLING INFORMATION IN REGARDS TO THE AGREED UPON PAYMET STRUCTURE DISCUSSED.