1. No category

REGISTRATION FORM
4.
To be completed by parent or guardian. Fill in all
sections with ink. This form may be copied for
additional registrations. Payment in full must
accompany this form.
1. APPLICATION
Last Name, First Name
Street Address
City, State and Zip Code
E-MAIL ADDRESS
AUTHORIZATION STATEMENT
I hereby approve of my child’s attendance at the
Heartbreakers Softball Camp and certify that she is
in good health and able to participate in the
program. I authorize that the directors act for me
according to their best judgment in any emergency
requiring medical attention. I understand, should
emergency conditions arise, I will be contacted. I
do hereby agree to release, discharge, and hold
harmless the camp, its officers, agents, and
employees of and from all causes, liabilities,
damages, claims or demands whatsoever on account
of any injury or accident involving my child arising
out of her attendance at this camp or in the course of
competition and/or activities held in connection with
this camp.
Birthdate
Insurance Carrier
Home Phone
2. TEE SHIRT SIZE
Circle Youth or Adult Size
YS YM YL AS AM
3.
Emergency Phone
AL AXL
Payment/Refund Information
Camp Fee
$150 – 1 camper
$280 – 2 siblings
$390 – 3 siblings
Registration fee covers instruction, camp prizes and a camp
tee shirt.
All cancellations must be received in writing. Full refunds
will be made for cancellations received at least 15 days
before camp begins. After this deadline, $30 will be
deducted for administrative expenses. For purposes of the
refund, the postmark of the cancellation letter will be used.
In case of inclement weather that causes cancellation of 3 or
more days, a credit will be issued for participation in the
following year.
Policy Number
Parent/Guardian Signature
5. MAILING INFORMATION
Send registration form and check (payable
to Heartbreakers Gold) to:
Heartbreakers Softball Camp
5704 Honey Glen Court
New Market, MD 21774
20th Annual Softball Camp
Dedicated in Loving Memory to
Amy Burdette Riggs
June 29-July 2, 2015
Girls Ages 7-15
(Born in 2000 to 2008)
Ballenger Creek Park
Frederick, MD
QUESTIONS?
301-639-7056
[email protected]
$15 returned check fee will be assessed.
For more information on the Heartbreakers
Gold team, please visit our website:
http://www.eteamz.com/heartbreakers18Ugold/
DAILY SCHEDULE: 8:45 AM – 2:00 PM
8:45 – 9:00 Campers arrive
9:00 – 9:15 Run, stretch, throw
9:15 – 10:00 Skill Session #1
10:05 – 10:50 Skill Session #2
10:55-11:40 Skill Session #3
11:45 – 12:30 Lunch Break
12:30 - 2:00 Games
Softball Skills That We’ll Cover
• Throwing Mechanics
• Fielding Skills (Position specific
including catcher, infielder, and
outfield skills)
• Basic Windmill Pitching Mechanics
• Hitting Mechanics (including
bunting and slapping)
• Baserunning and Sliding
• Teambuilding Exercises
WHAT TO BRING TO CAMP?
Campers will need to bring a lunch daily. Campers must
bring softball gloves and wear camp tee shirt. They may
bring a bat. All personal items need to be clearly labeled.
Sunscreen is strongly recommended. Unlimited water is
available but campers may want to bring a pre-filled water
bottle each day.
If the camper has special concerns such as the need for
medications or specific allergies, please include a
description of these needs in writing with the registration
form.
CAMP STAFF
PROGRAM FEATURES
Camp Director
Skills Instruction
Daily Games
Individual Competitions
Radar Gun to clock throwing speed
Prizes
Certificate of Completion
(For each Camper)
Skills Evaluation Report Card
Coach Terry Burdette
Softball Clinician
Head Coach of the 18 and Under Heartbreakers
Gold Tournament Team
Head Coach, Hood College
National Fastpitch Coaches Association
Heartbreakers Assistant Coaches:
Bobby Ambush
Ron Main
Pierre Bowins
Camp Instructors
Madison Ambush – Linganore HS
Kennedi Ambush – Linganore HS
Amanda Campbell – Walkersville HS
Dakotah Fraley – Walkersville HS
Madison Grimm – North Carroll HS
Annie McClain – Middletown HS
Sami Main – Middletown HS
Jessica Bryant – Catoctin HS
Kaleigh Edwards – Tuscarora HS
Sammie Bender – Chambersburg HS
Fiona Johnson – Magruder HS
Michaela Persinger – Catoctin HS
Other former HB Gold players will
assist upon availability
SAFETY PRECAUTIONS
First Aid Kit on site
Phone on site
CAMP LOCATION
Ballenger Creek Park in Frederick,
MD
CONTACTING CAMP
The Director of the camp has a
cellular phone on site (301-639-7056)
You will be notified by e-mail or
phone when we receive your check to
let you know that you are in the 2014
camp.