Please provide the following contact information:

First Name
Middle Initial
Last Name
Home Phone
E-mail

Address

Street
City
State
Zip Code

Please identify and describe yourself:

Date of Birth
Age
Sex	Male Female
School
Grade
Shirt Size:	YS YM YL AS AM AL AXL
Home Phone:
E-Mail Address:
Father’s Name:
Work/Cell #
Mother’s Name:
Work/Cell #
Primary Position:	First Base Second Base Shortstop Third Base Pitcher Catcher Outfield
Secondary Position:	First Base Second Base Shortstop Third Base Pitcher Catcher Outfield
22009 Summer Camps: June 1-5	June 1-5 June 1-5 Morning Only - $140.00 June 1-5 Full Day - $250.00
22009 Summer Camps: June 8-12	June 8-12 June 8-12 Morning Only - $140.00 June 8-12 Full Day - $250.00
22009 Summer Camps: June 15-19	June 15-19 June 15-19 Morning Only - $140.00 June 15-19 Full Day - $250.00
22009 Summer Camps: June 22-26	June 22-26 June 22-26 Morning Only - $140.00 June 22-26 Full Day - $250.00
22009 Summer Camps: All 4 weeks	All four weeks Morning Only - $420.00 Full Day - $750.00
Emergency Contact:
Relation:
Cell Phone #:
Home Phone #:
How did you hear about our camp?	TV Ad E-mail Website Word of mouth Baseball Clinic Mail Out Other
If Other, Please specify where
Conditions of Application   Full tuition payment is due when you send in this application form. If your child cannot attend the week of baseball school in which he is enrolled, a camp credit will be given to you to use at future Big Leagues Baseball Schools. I hereby authorize the staff of the Big Leagues of Baton Rouge to act for me, according to their best judgment, in any medical emergency and I hereby waive and release said persons from any liability or illness incurred while attending camp.
Name of Parent/Guardian:
Date:
Doctor’s Permission A dated note from a physician is required and must be provided no later that the day of registration for the camper. This note will be valid for all camps attended for the year 2009 should the camper attend more that one camp session. No camper will be allowed to participate without a doctor’s permission.
Doctor’s Permission	Big Leagues of Baton Rouge Baseball Camps Doctor Note
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Payment by Credit Card:  Mastercard or Visa only! To pay via credit card, please fill out the section below.
Type of Credit Card	Mastercard Visa
Name as it appears on card:
Credit card number:
Expiration date:
Full Amount to be charged: