Campers Information

First Name *

Last Name *

Grade *

Age (as of 10/1) *

The cost of the program is only $50 if registered before 4/10, $75 after that date

How did you hear about us?

Website

Newspaper

From a Friend

Other

If a High School player referred you, what was his name?

Parent/Guardian Information

Parent/Guardian Name *

Address 2

Town *

State

Zip

Email Address

An email confirmation will be sent upon receipt of your registration form.

Phone

Allergies *

Insurance Type & Number *

I give permission for my son to participate in the Panther Spring Baseball Clinics; I further agree to hold Whitman-Hanson Regional High School, Coach Dave Fouracre, all coaches, camp counselors, officials and agents free from any liability whatsoever in the event of any type of injury; I also certify that my son has been through a physical examination within the last 13 months and that he is healthy and able to participate in the program; I also give my permission for the program to seek medical attention for my son in the event of an injury, but again will not hold any of the above mentioned parties liable for said medical care or lack there of. If my son has any specific medical condition, I will notify the coaching staff in writing prior to the start of the program.

Date *

Parent/Guardian Signature

Please bring a signed copy of this form with you on the first day of the program.

Payment Information

Method of Payment: (Please remember the fee is $50 until 4/10, $75 after that date) *

I am sending a check (payable to WH Baseball) for $50 to: Dave Fouracre, Baseball Coach Whitman-Hanson Regional High School 600 Franklin Street Whitman, MA 02382

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