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Bulldog Summer
Baseball Camp
THIS FORM MUST BE COMPLETED AND SUBMITTED NO LATER THAN THE BEGINNING OF THE
FIRST SESSION IN ORDER FOR YOUR CHILD TO PARTICIPATE. NO EXCEPTIONS.
Name of Player: ______________________________ Birth Date: __________ Age on 6/1/15: ______
Home Address: ___________________________________________________________________
Medical Conditions/Allergies / Behavioral Issues [
] - None [
] or ______________________
(Initials)
(Check Box)
__________________________________________________________________________________
Sun Tan Application: We require you to provide sun tan lotion. After lunch all the campers will be
required to apply the sun tan lotion they bring. If they forget it, we will have lotion. Circle whether you
want us to apply our lotion should you child forget to bring it: Yes / No Initials: _______
Primary Adult Contact: Name: _________________________________ Relationship: _________
Cell Phone#: _______________ Home Phone#:_______________ Work Phone#:_______________
Secondary Adult Contact: Name: _________________________________ Relationship: _________
Cell Phone#: _______________ Home Phone#:_______________ Work Phone#:_______________
* * *
Person(s) authorized to drop off and/or pick up this child:
________________________________ Relationship: _______________________
________________________________ Relationship: _______________________
________________________________ Relationship: _______________________
If Authorized to leave on his/her own, sign here: ____________________________________________
I, ________________________________________
Print Name
Date: ________________ agree to the following:
Signature: _______________________________________
I hereby acknowledge that participation in athletic events (including instructional clinics and camps)
necessarily involves the risk of physical injury. My child has been examined by a doctor and has been
found physically fit to compete in athletics and participate in a baseball instructional camp. In
consideration of accepting the registration of this player, and permitting the voluntary participation of the
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player in it’s programs, I hereby release, discharge, and hold harmless the 78 Precinct Youth Council
(and it’s employees, volunteers, and any of its other representatives), any official (umpire, referee, etc.),
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and any manager, coach, instructor, or league official of any other organization or league which the 78
Precinct Youth Council may choose to enter from any claims arising out of or relating to any injury that
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may result to the player while participating in 78 PYC sponsored or approved events, including, without
limitation, practices, instructional clinics, and camps, and the loss of valuables or equipment that may
occur during, or traveling to or from, games and practices.
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Furthermore, I understand that NYC Code 10-138 and the 78 PYC codes of conduct are STRICTLY
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ENFORCED by the 78 PYC, and that any offensive behavior during games, practices, instructional
clinics, or camps by any coach, parent, player, spectator or other participant that violates this law and the
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78 PYC codes of conduct may result in that individual being banned from the ball field and/or activity.
Additional sanctions may be imposed including a permanent ban of said individual, INCLUDING THE
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PLAYER, from all activities sponsored by the 78 PYC. I hereby agree to follow all such rules and
regulations. Additionally I understand that all activities are played for both instruction and fun. All
emphasis is toward developing teamwork, toward playing to best and toward developing and
demonstrating the principles of good sportsmanship.
Furthermore, from time to time the names of players and/or their pictures may be publicly listed on the
78PYC website or other media to, for example, publicize this camp. I agree that such is permitted unless
I inform the Council in writing not to use a picture of my child and/or list my child’s name and/or to use a
pseudonym or alternate identification instead.
Makeups: There will be no makeups as the sessions will be held even if it rains. There will be no refunds.
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Drop off: 8:30-8:45am at the 9 Street entrance to Prospect Park (near the statue of Lafayette). If late, I
will bring my child directly to the fields (either field 4 or 5). If you don’t see the campers, call Marc Lussier,
II or Luis Monell (their numbers are listed below).
Pick Up: 2:30-2:45pm. If late (after 2:45pm), you will be charged a $25 sitting fee. If you don’t arrive by
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3pm your player will be taken to the 78 Precinct Stationhouse at 65 6 Avenue (718 636-6411). If it
happens a second time, your child’s participation will be cancelled with no refund. If you know in advance
that you will be late, call Marc or Luis – do not leave a message unless Marc AND Luis do not answer.
The person picking up your player must sign your player out.
Person Authorized to Pick Up: Only a person listed on this form will be allowed to pick up your player,
unless you have indicated above that your child is authorized to leave on his/her own
Health Issues: I have provided all the necessary information about any health condition of my child. If I
provided medication, I will give specific written instructions on its usage. If there is concern about health
issues, I accept that an adult may be required to stay for the entire session. In the event of an injury or
medical situation, the designated adult contact noted above will be called for instructions. However, if in
the opinion of the instructor immediate medical attention is needed or the designate adult contact(s) do
not answer, 911 will be called.
Insurance Carrier: ___________________________________ Id#:__________________________
Behavior: I will discuss the following with my child: to pay attention, to not fool around, to be respectful to
the instructors and the other kids, and to raise their hand to speak – just like in school. If it is determined
that my child is disruptive, an adult designated by me will, if requested, attend the balance of the
sessions. If that proves ineffective to the camp directors, I understand that my child’s participation will be
terminated with no refund.
Rain: If it rains, the players will play kickball in the Park (which is why they need a towel and change of
clothes) and/or go to an indoor location a block from the park where they will discuss baseball strategies
and watch videos.
What to Wear: T-shirt, sweatpants (long pants is required), hat, athletic supporter, socks, baseball shoes
or sneakers, suntan lotion, sunglasses.
What to Bring: A change of clothes (including shorts), suntan lotion, sunglasses, lunch, extra water in a
water bottle, baseball mitt, towel, medication (where required, with precise and clear instructions), and
cup for athletic supporter. Do NOT bring balls and bats.
Camp Instructors to Contact
Marc Lussier II: 347 234-9528 or Luis Monell: 347 440-5320 (For Elite Camp Only)