Double Play Baseball Camp
July 17-21 & July 24 28
9:00 am - 3:00 pm
Sweatt Field
Wrentham
Ages 7-14
Directors:
Al Smith Athletic Director/ Head Coach Randolph H.S.
Ed Moran Head Coach King Philip Regional High School
Jeff Plympton Wrentham Recreational Director/ Boston Red Sox
Registration:
NAME_______________________________________ DOB/GRADE_______________
ADDRESS____________________________________ TOWN_____________________
FATHERS NAME_________________PHONE# (H)____________(W)_____________
MOTHERS NAME_______________ PHONE# (H)____________(W)______________
INSURANCE INFORMATION
MUST BE COMPLETED
NAME OF INSURANCE COMPANY_________________________________________
POLICY #_____________________________________________________
MEDICAL RELEASE FORM
This is to certify that (print campers name)_____________________ has my permission to be treated at Caritas Norwood Hospital from July 17- 28, 2006 and that I authorize the camp director to act for me according to his best judgment in any emergency requiring medical attention if I cannot be reached.
DATE OF LAST TETANUS
BOOSTER_____________________________________________
ALLERGIES____________________________________________________________________
LIMITATIONS__________________________________________________________________
PERMISSION TO TAKE:
ASPIRIN________________ TYLENOL______________________
PRESENT MEDICATIONS_______________________________________________________
FAMILY DOCTORS NAME____________________________PHONE #_________________
EMERGENCY CONTACT NAME_________________________PHONE #________________
I understand that this registration fee is non-refundable and non-transferable after June 18, 2006. Failure to follow proper camp procedure regarding good behavior will result in dismissal from camp
without refund.
PARENT SIGNATURE_________________________________________________________
One Week - $300.00 Two Weeks - $500.00
For questions contact:
Al Smith (508) 384-8763, Ed Moran (508) 883-2218 or Jeff Plympton (508) 384-5427