Baseball Camp June 22-24

We collect demographic information for grant reporting purposes only; individual data is never used—only combined data is reported as a whole.
Player Name

First NameLast Name
Birthdate

MonthDayYear
Date
Gender
Race
This is used for Grant Purposes
Grade
School
Skill Level or Prior experience
Primary or secondary positions played
Handed thrower

Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Any Medical Conditions or Allergies
Please put NONE if not applicable
Health Insurance Carrier
Health Insurance Policy Number
Who will be picking up your child from camp?

First NameLast Name
CY-HOPE LIABILITY RELEASE: By signing below, I give permission for my child to participate in any Cy-Hope program or activity. On behalf of the participant in this program/activity, I release Cy-Hope staff and volunteers from any liability and all claims for any injuries or damages which might be sustained during any activity. I understand that the Hope Center program has an open-door policy, and they are not responsible for my child's actions once my child leaves the Hope Center builiding. (If you want to make sure your child comes straight home, or you do not want your child to walk home alone, please pick them up before the Hope Center closes.)

CY-HOPE MEDIA RELEASE: I, the parent/guardian, of the above-named child grant Cy-Hope or its affiliated organization's permission to publish names, images, and/or videos of my child in event publications, video publications on their website, and social media outlets. I hereby release Cy-Hope from any liability or claims for any injuries or damages incurred while participating in Cy-Hope events.
Parent/Guardian Signature

One Day Pass

$75.00

One Day Pass with Lunch Provided

$85.00

Two Day Pass

$140.00

Two Day Pass with Lunch Provided

$160.00

Three Day Pass

$200.00

Three Day Pass with Lunch Provided

$230.00

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