Fifteen Sports, Inc.

Baseball Camp

Summer 2016

Camp details:Ages 7-13

Dates: June 13 – 16, 2016 (camp 1)Location: Stumpy Creek

July 11 – 15, 2016 (camp 2) 160 Stumpy Creek

Sign up for both dates! Mooresville NC 28115

Time: 10:00a.m. – 2:00 p.m.

Cost: $80.00 per week (camp) (preregistration preferred)

$150.00 if you preregister for both camps by June 5, 2016.

Camp T-shirts will be an additional $15.00.

Registration:

To register, please fill out the attached form. Return the completed form (required) and camp fees to Fifteen Sports at the address provided below or register the first day of camp between 9:30 a.m. and 10:00 a.m.If you plan to register the first day of camp, please send an email and let us know you are coming!!

Make checks payable to: Fifteen Sports, Inc.

Mail to:1480 Mt. Ulla Highway

Mt. Ulla NC 28125

Please include registration form.

Camp Features:Participants needs:

Hitting instructionAppropriate clothing

Base running instructionBaseball hat

Infield instructionSunscreen

Outfield instructionAny gloves, bats, batting gloves, etc

Pitching instructionLunch (water will be provided)

Catching instructionAppropriate protective equipment

Additional information:

Sheila Allman 704-662-3014

Director:Coach Reece Honeycutt 704-880-8674

Instructors will include experienced coaches and collegiate players. For more information concerning our instructors, please contact us!

Thank you for your interest in the 3rd annual 15 Sports Baseball Camp!

Please fill this form out completely and return.

General Information

Name: / Date of Birth:
Address: / Grade: / T-shirt size:
Phone:

Parent/Guardian Information

Name: / Home phone:
Address: / Cell phone:
e-mail:
Name: / Home phone:
Address: / Cell phone:
e-mail:

Emergency Contact (contact will be made in order as listed)

Name: / Phone:
Name: / Phone:
Name: / Phone:

Waiver and Release

My child has permission to participate in the 2016 Fifteen Sports Baseball Camp. I certify that within the past year my child (named above) has had a physical examination and that my child (named above) is physically able to participate in all camp activities. In the event of illness or injury, I hereby give consent for medical treatment to be administered. I also give permission to any physician who may need to become involved, the right to hospitalize, secure proper treatment and order injections, anesthesia, or surgery. I will be responsible for all medical or other charges in connection with my child’s attendance at camp. I also certify that my child is covered by the following insurance.

Insurance Information (required)

Insurance name and address: / Policy #
Group#

Are there any restrictions on the camper’s participation? Yes_____ No ______

If so, explain in full ______

Applying for acceptance to this camp, I, intending to be legally bound, hereby for myself, my heirs, executors and administers, waive and release any and all rights and claims I may have against Iredell Parks and Recreation Department, Fifteen Sports, Inc., or its representatives (including director and instructors) for damages or injuries that may be sustained by my child while participating in the Fifteen Sports Baseball Camp.

______

Parent/ Guardian Date Parent/Guardian Date