Sponsors of.... BASEBALL 231 Greenwood Ave * Midland Park, NJ 07432 * www.battingcircuit.com (p)201-857-5353 * (f)201-857-5354 2015 Summer Baseball and Softball Registration Form Please return the completed form to [email protected] or mail this along with your check to The Batting Circuit, Attn: Steve Bussanich, 231 Greenwood Ave Midland Park, NJ 07432 Please Select Clinic: ____ Baseball Summer Camp July 13-16, 2015 ____ Softball Summer Camp July 13-16, 2015 Childs’s Name: _____________________________________________Child’s Age/Birthday: ______________ Address: ___________________________________________________________________________________ City: ______________________________________ State: ____________ Zip:______________ Parent/Guardian Name: ____________________________________________ Cell Phone: ________________ Email: ______________________________________ Home Phone: ______________________ Emergency Contact Name: _______________________________ Contact Phone: ________________________ Medical Concerns: ____________________________ Allergies: _________________________ Payment Method- Please circle one: Check / Cash/credit Card Credit Card # ______________________________ Exp Date: _________ Amount: $ ________________ Check #:_______________ Please note, there is a $3.00 credit card fee. or Cash Amount: $_____________________________ -----------------------------------------PARENT/GUARDIAN RELEASE----------------------------------------Waiver & Release of liability: I __________________________________, hereby certify that the participant is in good health and able to participate in the prescribed, above activity. Furthermore, I agree and hold harmless The Batting Circuit, LLC, its owners, instructors and employees, from all liability arising out of any injury or accident sustained by the participant in the course of his/her activity. If a medical emergency should arise and I cannot be reached immediately at home or at the emergency phone number, I hereby grant medical personnel the authority to take whatever means he or she deems necessary to safeguard the welfare of the participant.