Tuesday June 16, 2015 9:00AM-4:00PM Limited to first 40 campers!!! All Skills (Hitting, Fielding, Throwing, and Running) Ages: 9th grade & Up Cost: $50.00 Lunch Included Location: UT Tyler Ballpark/ UT Tyler Campus ALL REGISTRATION MUST BE SENT TO [email protected] Participant’s Name: ______________________________________ High School: ___________________________ Email: ____________________________________________________ Select Team: __________________________ Circle All That Apply: RH hitter LH hitter LH slapper Parent’s Names: __________________________________________Address:______________________________________ City/State/ ZIP: __________________________________________________ Phone: ______________________________ Primary Position: ____________ Secondary Position: ______________ Grad Year: _________________________ Emergency Contact: ________________________________________ Phone: _________________________ Medical Release and Photography Release Statements These statements must be signed by parent/guardian before the child can participate in camp. I certify that my child is physically fit for all softball camp activities and grant permission in case of injury, accident or illness that she be treated by a licensed physician. Furthermore, I release the University of Texas at Tyler, in officers, directors and all associated with the camp from any and all liability for personal injury arising out of the applicant’s participation in the camp. Parent/Guardian Signature__________________________________________________ Date: _________________________ I agree to allow the participant listed above to participate in the photo opportunities available at the University of Texas at Tyler and give UT Tyler permission to use photos of my child in any advertising or marketing promotions (print, electronic, outdoor advertising, faculty presentations and publications.) All prints, slides and digital images belong to UT Tyler solely and completely. Parent/Guardian Signature__________________________________________________ Date:_________________________ Credit Card Payment: Amount $50 Name on Card:______________________________________ Type of Credit Card:____________________________________ Credit Card Number: _________________________________________________ Expiration Date: _______________________ Security Code: ________________ Signature of Card Holder:______________________________________ Cards will not be charged until 72 hours prior to camp date to assure no rain outs or refunds. IF YOU DO NOT RECEIVE A CONFIRMATION EMAIL WITHIN 72 HOURS PLEASE RESEND THIS FORM. FOR MORE INFORMATION CALL:UT TYLER SOFTBALL 903-565-5820