Torreys Baseball Camp Registration Form
Email address *
Camper's First Name *
Your answer
Camper's Last Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Grade in Fall 2019 *
Your answer
Parent 1 Name *
Your answer
Parent 1 email
Your answer
Parent 1 Cell Number *
Your answer
Parent 2 Name
Your answer
Parent 2 cell number
Your answer
Medical authorization: In case of medical emergency, I understand that every effort will be made to contact parents or guardians of campers. In the event I can not be reached, I authorize medical treatment. Such treatment is to be rendered by, or under the jurisdiction of, a duly licensed medical doctor or dentist. You are fully authorized to act in accordance with your judgement in any such emergency and are absolved from any liability or financial responsibility in connection therewith. (Your electronic Signature below acknowledges Consent.) *
Your answer
Health Insurance Company *
Your answer
Policy Holder or Employer *
Your answer
Group or Policy Number *
Your answer
Name of Doctor *
Your answer
Doctor Phone Number *
Your answer
Name of Dentist *
Your answer
Dentist Phone Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Relationship *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of La Jolla Country Day School. Report Abuse - Terms of Service