HOME OF THE 1965, 1969
STATE CHAMPION RUNNER-UP
2015 Monroe Area Baseball
“Summer Camp”
Ages: Rising 1st through 8th graders
Hosted by: Head Baseball Coach, Chad Kitchens
Monroe Area Baseball Coaching Staff, and Current Monroe Area Baseball Players
Location: Monroe Area High School Baseball Field
Dates: May 18-21, 2015
Registration: Monday, May 18th at 2:00pm
Time: 3:00pm – 6:00pm (t-shirt provided)
Cost: $85
DEADLINE FOR REGISTRATION: May 11, 2015
**Spaces are limited so return the form ASAP**
Campers Name:
_______________________________________________Age: ______
(Last)
(First)
Home Address:
________________________________________________________________________
(Street)
(City, State, Zip)
Name of Parents/Guardians:
__________________________________________________
E-mail address:
____________________________________________________________
Home Phone: ____________________________Cell: ___________________________
***Please designate which would be emergency contact number by circling***
300 Double Springs Church Rd
Monroe, GA 30656
PHONE 770-266-4599 FAX 770-266-4598
www.monroeareabaseball.com
HOME OF THE 1965, 1969
STATE CHAMPION RUNNER-UP
Release Waiver of Liability (please read carefully before signing)
The undersigned hereby acknowledges that participation in this camp and related
activities involves an inherent risk of physical injury and the undersigned, on behalf of
the registrant, hereby assumes all such risk and does hereby release and forever discharge
the camp and all employees and agents thereof from any and all liability of whatever kind
and nature, arising from and by reason of any and all known, foreseen and unforeseen,
bodily and personal injuries, damage to property, and the consequences thereof, resulting
from this registrants participation in or involvement with this camp, including any failure
of equipment or defect on or in the premises.
I hereby state that I am legal guardian of said child:
Date: _________ Participants Name: ______________________
Parent Signature: ______________________________________
Insurance Information:
Primary Company Name: ___________________________________
Policy #: ________________ Group #: ____________________
Phone #: _____________
RETURN REGISTRATION FORM AND CHECK PAYABLE TO
“Monroe Area Dugout Club”
Chad Kitchens
300 Double Springs Church Road
Monroe, GA 30656
300 Double Springs Church Rd
Monroe, GA 30656
PHONE 770-266-4599 FAX 770-266-4598
www.monroeareabaseball.com