CISC and LIBA Camp Registration Form

PERSONAL INFORMATION
Camper's Name:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone:
Work Phone:
E-mail:
Age:
Date of Birth:

MonthDayYear
Parent's Name(s):
Emergency Contact:
Emergency Contact Phone:
Shirt Size:
League or Travel Organization (if applicable):
CAMP INFORMATION

Early Bird special, pay in full by June 11 and receive $10 off each site per week for multiple weeks.
Choose One:
Center Island Sports Indoor Facility: CHOOSE ONE
Dates
Stony Brook University: (9am-4pm) Baseball Camp Only
Payment Information
Credit Card:
Card Number:
Expiration Date:mm/dd/yyyy
Total Amount ($$):
Please enter the characters that appear on the image :
Should be Empty:

PERSONAL INFORMATION