REGISTRATION FORM
For each camp/camper, please use a separate
registration form and separate check.
MAKE CHECKS PAYABLE TO THE SPONSORING TEAM
(ie: Bay Shore Baseball, Bay Shore Field Hockey)
SEND REGISTRATION AND PAYMENT TO:
Bay Shore Athletics/HPEA, 75 W. Perkal St., Bay Shore, NY 11706
Camp: ______________________ Check #: _______________
Name (Last, First): __________________________________
Home Phone: ___________________
Address: ___________________________
Town/Zip: _____________________ Emergency # - 1: ________________
Grade as of Sept. ‘11: _____ Parent/Guardian Name(s): ________________ Emergency # -2: _________________
Medical Restrictions: NO_____ YES_____ (Explain on separate sheet)
Medical Disclaimer: My son/daughter is in good health and has my full permission to participate in a vigorous camp program. He/she has no previous illness or bodily injury that is contradictory to participation. In the event I cannot be reached, I give my full permission for such medical procedures deemed necessary by an examining physician.
_______________________________________ ____________ Parent/Guardian Signature Date
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