Team Virginia Softball Indoor Clinic Registration

Team Virginia Softball Indoor Clinic Registration
Player's First and Last Name

First NameLast Name
Players Date of Birth

MonthDayYear
Date
Positions - Check all that apply
Parent First and Last Name

First NameLast Name
Parent's Email
example@example.com
Parent's Cell Phone

Area CodePhone Number
Parent's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Insurance Carrier
Insurance Agreement #
Emergency Contact Information
Contact Name

First NameLast Name
Contact Phone

Area CodePhone Number
Age Level
Choose one or more of the following: Each Session is $10 and is limited to 20 participants
If you prepay for 3 sessions you will receive a Team Virginia t-shirt
T Shirt Size
Any questions please contact Erika Lamper at 540-222-9011
Please note: When prepaying, please list your daughters name on the Paypal payment so your payment can be properly credited to you.
Should be Empty:

Emergency Contact Information