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Holiday Baseball Camp*

Camper Attending

Camper's Name*

First Last

Camper's Address*

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

School Attending (2024-2025 school year)*

Grade as of (Aug. 2024)*

Birthday (MM/DD/YY)*

Age*

Field Position(s)

Legacy Name (If Applicable) and Grad Year

(ex. Father, Grandfather, Brother, Uncle)

Parent/Guardian Information

Parent/Guardian's Name*

First Last

Parent/Guardian's Address*

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Parent/Guardian's Phone*

Parent/Guardian's Email*

Parent/Guardian's 2nd Email

Emergency Contact Information

[Enter N/A in boxes if not applicable.]

Name (other than parent)*

First Last

Relationship*

Phone*

Family Physician*

Physician's Phone*

Insurance Company Information

[Enter N/A in boxes if not applicable.]

Company*

Primary*

Policy Number*

Hospital*

Allergies, Reactions, or Other Comments

Parental Consent

By submitting your registration, you agree to the following: I hereby give written permission for my child to attend this camp at Brother Martin. As a parent/guardian, I do hereby authorize the treatment by a qualified and licensed medical doctor in an emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurements, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me. Enrollment of a child in a Brother Martin Holiday Baseball Camp constitutes the consent of his parents or guardians for the student’s name, voice or likeness to be used in news publications, audio-visuals, and other electronic transmissions including the school’s website. I hereby give permission for my child to be transported by school bus to and from off-campus field trips.

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COVID-19 Parental Consent

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COVID-19 Parental Consent Form

Please upload or turn in your signed COVID-19 Parental Consent Form before the start of camp.

Drop files here or Select files

Accepted file types: jpg, png, pdf, docx, doc, Max. file size: 80 MB.

Credit Card

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Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date

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Total

Includes 2.5% processing fee.