Baseball Camp Registration
 

Name of Parents / Guardians (required)

Home Church (if applicable)

Child's Name (required)

Child's Age (required)

Child's T-shirt size (required)

Child's Name

Child's Age

Child's T-shirt size

Child's Name

Child's Age

Child's T-shirt size

Address (required)

City, State, Zip Code (required)

Phone Number (required)

Your Email (required)

Emergency Contact Name & Phone Numberl (required)

Additional Emergency Contact Name & Phone Number

Allergies (if any)

Family Physician (required)

Emergency Hospital Preference (required)

Any additional information you would like to provide

I give permission for my child / children to participate in Baseball Camp at Poplar Springs Baptist Church (required)
YesNo

I give permission for my child / children to be photographed during Baseball Camp activities. These photos may be used on the church website or in church publications. Names will not be listed. (required)
YesNo

I give permission for the Baseball Camp staff / volunteers at Poplar Springs Baptist Church to administer basic first aid and to pursue medical help as needed for my child / children in the event that parents or guardians may not be reached. (required)
YesNo

By typing my name in the box below, I agree to hold harmless Poplar Springs Baptist Church, Inc., its employees, volunteers and / or representatives, as well as any providers of services and products, from any harm or damage my child may incur while participating in Baseball Camp 2017. (required)