2017 Winter Boot Camps @ Rosemont Dome Registration Form
All parents are required to sign a medical and media waiver prior to Boot Camps. The waiver can be found on our website www.chicagomudcats.com under "Lessons, Clinics, Camps & Fitness/Clinics/Winter Boot Camps. Please print and sign this waiver either email it to mudcatsstringer@gmail.com or have your player bring it with them to the Boot Camps. Players will not be allowed to participate without a completed waiver on file.
PLAYER INFORMATION
You must complete a separate form for each player you are registering for Boot Camps
Player First Name *
Your answer
Player Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
School Attending/Grade (2017-2018 School Year) *
Your answer
Grade Level for 2017-18 School Year *
Your answer
2017 Team/Age Group *
Your answer
2018 Team/Age Group *
Your answer
Player Email Address *
Enter N/A if not applicable
Your answer
Player Cell Phone Number *
Enter N/A if not applicable
Your answer
Player Home Phone Number *
Enter N/A if not applicable
Your answer
Please List Medical Conditions for Player (if any) *
Enter N/A for none
Your answer
Please List Allergies for the Player (if any) *
Enter N/A for none
Your answer
Will the Player Bring an Epi-Pen or Inhaler to Boot Camps? If so please list below. *
Enter N/A for none
Your answer
PARENT/GUARDIAN INFORMATION
PRIMARY CONTACT
Relationship to Player *
First Name *
Your answer
Last Name *
Your answer
Primary Email Address *
Your answer
Secondary Email Address
If Applicable
Your answer
Home Phone Number *
Enter N/A if not applicable
Your answer
Mobile Phone Number *
Enter N/A if not applicable
Your answer
Work Phone Number *
Enter N/A if not applicable
Your answer
Best Way to Reach You *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Occupation *
Your answer
Employer & Title *
Your answer
Player Resides With...
PARENT/GUARDIAN INFORMATION
SECONDARY CONTACT
Relationship to Player
First Name
Your answer
Last Name
Your answer
Primary Email Address
Your answer
Secondary Email Address
Your answer
Home Phone Number *
Enter N/A if not applicable
Your answer
Mobile Phone
Enter N/A if not applicable
Your answer
Work Phone
Enter N/A if not applicable
Your answer
Best Way to Reach You *
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Occupation
Your answer
Employer & Title
Your answer
EMERGENCY CONTACT INFORMATION
Please indicate below two emergency contacts IN ADDITION to those listed above
EMERGENCY CONTACT INFORMATION - #1
Emergency Contact #1 First Name *
Your answer
Emergency Contact #1 Last Name *
Your answer
Emergency Contact #1 Home Phone *
Your answer
Emergency Contact #1 Mobile Phone *
Your answer
Emergency Contact #1 Work Phone *
Your answer
Emergency Contact #1 Relationship to Player *
Your answer
EMERGENCY CONTACT INFORMATION - #2
Emergency Contact #2 First Name *
Your answer
Emergency Contact #2 Last Name *
Your answer
Emergency Contact #2 Home Phone *
Your answer
Emergency Contact #2 Mobile Phone *
Your answer
Emergency Contact #2 Work Phone *
Your answer
Emergency Contact #2 Relationship to Player *
Your answer
YOUTH BOOT CAMPS 10U-14U
Youth INFIELDER Boot Camp (Four-Week Session)
Once a week for four weeks = $140 / Twice a week for four weeks = $250
Youth INFIELDER Boot Camp (Single Day)
$50/day - you may sign up for more than one day
Youth PITCHER Boot Camp (Four-Week Session)
Once a week for four weeks = $140 / Twice a week for four weeks = $250
Youth PITCHER Boot Camp (Single Day)
$50/day - you may sign up for more than one day
Youth CATCHER Boot Camp (Four-Week Session)
Once a week for four weeks = $140 / Twice a week for four weeks = $250
Youth CATCHER Boot Camp (Single Day)
$50/day - you may sign up for more than one day
HIGH SCHOOL BOOT CAMPS 15U-18U
High School INFIELDER Boot Camp (Four-Week Session)
Once a week for four weeks = $140 / Twice a week for four weeks = $250
High School INFIELDER Boot Camp (Single Day)
$50/day - you may sign up for more than one day
High School PITCHER Boot Camp (Four-Week Session)
Once a week for four weeks = $140 / Twice a week for four weeks = $250
High School PITCHER Boot Camp (Single Day)
$50/day - you may sign up for more than one day
High School CATCHER Boot Camp (Four-Week Session)
Once a week for four weeks = $140 / Twice a week for four weeks = $250
High School CATCHER Boot Camp (Single Day)
$50/day - you may sign up for more than one day
ADDITIONAL INFORMATION
Were you referred by anyone? If so, please provide their name.
Your answer
Please list names and phone numbers of those authorized to pick up your player from boot camps.
Players will not be released to anyone that is not on the authorized list
Your answer
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