Panther Baseball Camp High School Registration

Please complete this form and mail to:

Baseball Office
Chapman University
One University Drive
Orange, CA 92866
Attn: Coach Tom Tereschuk

Make check payable to: Chapman University

Camp Date: October 16-17, 2010
Camp Fee: $250.00

Player Name: ____________________________________
Parent(s) Name:__________________________________
Address: ________________________________________
City: _____________________ Zip: ________________
Home Phone: _____________________________________
Cell Phone: _____________________________________
Email: __________________________________________
Age: ______ DOB:________ Ht:________Wt:__________
High School: ____________________________________
Year of Graduation: _____________________________
Cumulative GPA: ___________ SAT/ACT: ____________
Position(s): ____________________________________
Bats (Circle one.): R L S
Throws (Circle one.): R L
T-shirt Size: S______  M______ LG______ XL______

I hereby authorize the staff of Chapman University Panther
Baseball Camp to act for me according to their best
judgement in any emergency requiring medical attention. I
consent to the above person participating in these
activities and assume the risk of accident or injuries from
whatever cause in connection therewith and release Chapman
University and their officers, agents and employees from
any and all liability for any such accident or liability.

_____________________________________
Parent/Guardian Signature