Future Prospects Baseball Camp

* = required

Player’s Name: *

Player’s Home Phone:*

Address:*

City:*

Zip:*

Date of Birth:*
(mm/dd/yyyy)

School:*

Player's School Grade as of Fall 2012:*

Mother’s Name:*

Home Phone:*

Cell:*

Mother's Email:*

Father’s Name:*

Home Phone:*

Cell:*

Father's Email:*

Player's Email:*

Player's Age on May 1st, 2012 ("Baseball Age"): (required)

Medical Insurance:*
 Yes No

Carrier:*

Carrier Phone:*

Family Doctor:*

Family Doctor Phone #:*

Emergency Contact:*

Emergency Contact Phone #:*

Does the Player have any physical or medical problems? *
[radio* MedicalProblems "Yes" "No"]

Is the Player allergic to any type of medicine? *
[radio* Allergies "Yes" "No"]

Please explain any "yes" above:

I as the parent or legal guardian of the applicant, do hereby give my approval to his participation in any and all activities of the Future Prospect's Elite Baseball Program. I assume all risks and hazards incidental to such participation including transportation to and from the activities; and I do hereby waive, release, absolve, indemnify and agree to hold harmless the Future Prospect's Elite, its Board of Directors, sponsors, managers, coaches and any volunteers connected with this program, from any and against any and all liability for any injury suffered by me or my child arising out of or in any way connected with participation in the Future Prospect's Elite Baseball Program.

In addition, permission is hereby granted to the Future Prospect's Elite to have the above named player taken to a hospital and emergency medical aid administered as the physician on duty deems necessary. I accept financial responsibility for any medical costs not covered by the Future Prospect's Elite secondary insurance coverage.

Please Initial Here: *