THE LONG ISLAND BASEBALL ACADEMY
ONLINE REGISTRATION FORM: Please complete the form below and one of our staff members will contact you. Thank you
PERSONAL INFORMATION
Player's Name:
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Address
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City:
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State:
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Age:
D.O.B.
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Parent(s) Name:
Parent(s) Email:
Home Phone:
*
Work Phone:
Emergency Contact Name:
*
Contact Phone:
*
Shirt Size: Youth
M
L
Shirt Size: Adult
M
L
XL
CHOOSE A PROGRAM
Check one:
Full Day Camp - Ages 6-14, 9am-3pm
Flex Day Camp - Ages 5-14, 9am-1pm
CHOOSE LOCATIONS/CAMP SESSIONS
Smithtown, NY Indoor: Long Island Baseball Academy
6/30 - 7/3
7/6 - 7/10
7/13 - 7/17
7/20 - 7/24
7/27 - 7/31
8/3 - 8/7
8/10 - 8/14
8/17 - 8/21
8/24 - 8/28
Stony Brook University: Stony Brook, NY; 9am-4pm
6/29 - 7/3
7/6 - 7/10
7/13 - 7/17
7/27 - 7/31
8/3 - 8/7
PAL baseball Complex: Holbrook, NY
7/6 - 7/10
7/13 - 7/17
8/17 - 8/21
Half Hollow Hills East High School: Dix Hills, NY
7/13 - 7/17
7/20 - 7/24
8/10 - 8/14
Kings Park High School: Kings Park, NY
6/30 - 7/3
7/6 - 7/10
7/13 - 7/17
7/27 - 7/31
8/3 - 8/7
Smithtown, NY Outdoor: Moriches Road LL Complex
8/17 - 8/21
8/24 - 8/28
Centereach Unity Drive School: Centereach, NY
7/6 - 7/10
8/10 - 8/14
Connetquot Youth Association: Bohemia, NY
7/20 - 7/24
7/27 - 7/31
PAYMENT INFORMATION
EARLY BIRD SPECIALS: Paid in full by May 15, 2009
TAKE $10 OFF: Each site per week for multiple weeks!
Check: (make checks payable to: L.I. Baseball Camps, INC.)
Pay by check
Credit Card:
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Mastercard
Visa
Amex
Account No.:
Expiration Date"
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Total Amount To Be Charged To CC:
Conditions of Attendance: I do hereby release, discharge, indemnify and hold harmless Long Island Baseball Academy, and its owners, directors, officers, employees, agents, successors, and assigns from and against, and waive any and all claims or liabilities for, any injuries, losses or damages, including without limitations, injuries to my child, my self and/or property, arising out of or incident to my child’s participations in Long Island Baseball Academy’s 2008 Summer Baseball Camps.All payments are non-refundable including cancellation due to inclement weather. Player may apply registration fee towards future events. Permission is hereby given to Long Island Baseball Academy to use photographs and/or endorsement of the players. Long Island Baseball Academy is not responsible for any lost or stolen property. Dates and times of camp sessions subject to change.
A CONFIRMATION LETTER WILL BE SENT TO YOU UPON RECEIPT OF REGISTRATION FORM AND PAYMENT
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