Untapped Potential Pitching camp Registration

Athlete Registration
Player Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Information
Name of Emergency Contact

First NameLast Name
Phone Number

Area CodePhone Number
Confirmation

I hereby declare that I give my full express consent to let my child be given immediate treatment by any qualified medical personnel in circumstances which may need immediate attendance and care.
Insurance

Medical Information
In case the parent/guardian is out of reach at the time of emergency, with consent of the latter, we will exercise the required diligence needed to have the athlete treated by an E.R Physician. In this regard, we would like to get to know any precautions that we need for the athlete
Any Allergies to Medicine and Antibiotics?

Parental/Guardian Consent
Waiver

I am aware that any physical sport activity may cause accidental injury or harm among the athletes. I agree to waive my right to pursue any claim against Untapped Potential Pitching or Batters Box.
Name

First NameLast Name
Relationship to athlete
Payment must be made to @Doria-Chancey via Venmo to secure spot.
Should be Empty: