VIKING BASEBALL CAMP
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JUNE/JULY 2012
Please make check or money order payable to Viking Baseball Inc.
PRINT AND FILL OUT ENTIRE FORM (registration and consent form).
Mailing address:
Viking Baseball Camp
P.O. Box 3614 Wantagh, N.Y. 11793
Attn. Mike Milano
Camp Rates 2012 Discounts are for multiple week registration ONLY
DISCOUNTS DO NOT APPLY TO WALK-UP REGISTRATION
1 week = $ 175
2 week (RATE SPECIAL) = $ 330
3 week (RATE SPECIAL) = $ 495
PLEASE CHECK ALL THAT APPLY:
[] Week #1: June 25 – June 29 : 9am - 1pm (Grades 2nd - 8th)
[] Week #2: June 2 – June 6 : 9am - 1pm (Grades 2nd - 8th)
(we will have camp on the 4th of July)
[] Week #3: July 9 – July 13: 9am - 1pm (Grades 2nd - 8th)
Camper’s Name_____________________________________________School_______________
Grade Entering 9/2012______Age_________D.O.B_____________________
Parent/Guardian Name________________________________________________
Address_________________________________________________________Town________________
Zip________________Home Phone___________________________Cell Phone__________________
Work Phone_________________________*Email Address________________________________________
Emergency Contact Name/Phone___________________________________________
Please list allergies/Meds____________________________________________
Shirt Size: Youth M, YL, AdultS, AM, AL, AXL
(*Please Circle One Size*)
PRINT AND FILL OUT ENTIRE FORM (registration and consent form).
Mailing address:
Viking Baseball Camp
P.O. Box 3614 Wantagh, N.Y. 11793
Attn. Mike Milano
Camp Rates 2012 Discounts are for multiple week registration ONLY
DISCOUNTS DO NOT APPLY TO WALK-UP REGISTRATION
1 week = $ 175
2 week (RATE SPECIAL) = $ 330
3 week (RATE SPECIAL) = $ 495
PLEASE CHECK ALL THAT APPLY:
[] Week #1: June 25 – June 29 : 9am - 1pm (Grades 2nd - 8th)
[] Week #2: June 2 – June 6 : 9am - 1pm (Grades 2nd - 8th)
(we will have camp on the 4th of July)
[] Week #3: July 9 – July 13: 9am - 1pm (Grades 2nd - 8th)
Camper’s Name_____________________________________________School_______________
Grade Entering 9/2012______Age_________D.O.B_____________________
Parent/Guardian Name________________________________________________
Address_________________________________________________________Town________________
Zip________________Home Phone___________________________Cell Phone__________________
Work Phone_________________________*Email Address________________________________________
Emergency Contact Name/Phone___________________________________________
Please list allergies/Meds____________________________________________
Shirt Size: Youth M, YL, AdultS, AM, AL, AXL
(*Please Circle One Size*)
CONSENT
The entire fee must accompany the application, which is non-refundable. I understand that any
camper who does not abide by rules and regulations promulgated by the camp is subject to
dismissal without reimbursement or recourse. The camp is not responsible for injury or illness
if same was not caused through fault of camp. I hereby authorize the Viking Baseball Inc., camp
to act for me according to their best judgment in any emergency situation.
Print Camper's Name __________________________________ Date____________
Signature of Parent / Guardian X_____________________________________________
The entire fee must accompany the application, which is non-refundable. I understand that any
camper who does not abide by rules and regulations promulgated by the camp is subject to
dismissal without reimbursement or recourse. The camp is not responsible for injury or illness
if same was not caused through fault of camp. I hereby authorize the Viking Baseball Inc., camp
to act for me according to their best judgment in any emergency situation.
Print Camper's Name __________________________________ Date____________
Signature of Parent / Guardian X_____________________________________________
| Viking Baseball Inc.,“The distribution of this flyer by the Seaford School District is a courtesy extended to the activities of this organization. In no way does the Seaford School District sponsor or accept any responsibility for these activities" |
