Torreys Baseball Camp Registration Form
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Email *
Camper's First Name *
Camper's Last Name *
Birth Date *
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/
DD
/
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Grade in Fall 2019 *
Parent 1 Name *
Parent 1 email
Parent 1 Cell Number *
Parent 2 Name
Parent 2 cell number
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.) *
Health Insurance Company *
Policy Holder or Employer *
Group or Policy Number *
Name of Doctor *
Doctor Phone Number *
Name of Dentist *
Dentist Phone Number *
Emergency Contact Name *
Emergency Contact Number *
Relationship *
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