Winter Camp 2021 Queens

BALLPLAYER'S NAME *

First Name Last Name

BALLPLAYER'S CELL

Please enter a valid phone number.

BALLPLAYER'S EMAIL

example@example.com

PARENT NAME *

First Name Last Name

PARENT CELL *

Please enter a valid phone number.

PARENT EMAIL *

example@example.com

ALTERNATE CONTACT NAME

First Name Last Name

ALTERNATE CONTACT CELL

Please enter a valid phone number.

ALTERNATE CONTACT EMAIL

example@example.com

HOME ADDRESS *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

DATE OF BIRTH *

Date

AGE AT DATE OF CAMP *

CURRENT SCHOOL *

HIGH SCHOOL CLASS OF *

POSITION (PRIMARY) *

POSITION (SECONDARY)

INSTAGRAM HANDLE

HAVE YOU ATTENDED ANY OF OUR CAMPS IN THE PAST? *

Yes No

HOW DID YOU HEAR ABOUT US?

Health Certification and Disclaimer:
My child is in good health and he/she has my permission to participate in the baseball camp. He has had no previous illness, disease or bodily injury which would prevent his/her participation in all camp activities. I further understand that there is a risk of injury related to participating in the baseball camp and agree that the facility at which the camp is held, Dom Scala Baseball Inc., their respective employees, agents, subcontractors and representatives are not liable or responsible for any injuries or damages to person or property that may occur involving my son/daughter. I hereby indemnify and hold harmless the facility at which the camp is held, Dom Scala Baseball Inc., and the staff of the baseball camp, their employees, agents, subcontractors, officers, directors and staff from any liability arising out of the participation of my son/daughter in the baseball camp. I hereby advise the officers of the facility and baseball camp that I / we have adequate health insurance to provide for and pay for any medical costs that may directly or indirectly result from the participation of my son/daughter in this camp.

I AGREE TO THE ABOVE HEALTH CERTIFICATION AND DISCLAIMER (PLEASE TYPE YOUR FULL NAME) *

REFUND POLICY

Requests for cancellation must be sent in writing to info@domscalabaseball.com. Cash Refunds will ONLY be issued if cancellation occurs more than14 days before the start of camp and shall be made for the amount paid, less a $95.00 administrative fee. If cancellation occurs within two weeks of camp's start date, a credit to be used towards a future camp will be issued less the administration fee.

I AGREE TO THE ABOVE REFUND POLICY (PLEASE TYPE YOUR FULL NAME) *

PLEASE LIST ANY MEDICAL CONDITIONS, ALLERGIES, OR SITUATIONS OF WHICH WE SHOULD BE AWARE, INCLUDING INHALERS AND EPIPENS (OR STATE "NONE") *

SELECT PACKAGE *

5 Sessions

$ 360.00

Enter coupon

Total

$ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

PLEASE SELECT THE DATES YOU WOULD LIKE TO ATTEND *

November 10 December 1 November 17 December 8 November 24 December 15

CONTACT INFORMATION

BALLPLAYER DETAILS

CAMP INFORMATION