2022 Camp Registration Form

Player Name(required)

Age(required)

Team(required)

Position(required)

T Shirt Size(required)

Parent Name(required)

Phone(required)

Address(required)

Parent Email Address(required)

Parent Phone Number(required)

Choose which camp you will be attending

Fayette County Youth Camp at Hopwood June 6-7-8 (Ages 6-14) Mon Valley Youth Camp at Belle Vernon June 20-21-22 (Ages 6-14) Greene County Youth Camp at Carmichaels July 11-12-13 (Ages 6-12)

Parent Physical Consent Waiver I give my permission to participate in Coach Encapera’s Baseball Camp. My child has had a recent physical exam and is physically able to participate in all clinic activities. I certify that my child has adequate medical insurance and I relieve the Directors of the clinic, the student helpers, the park owners, or municipality of any responsibilities or liability should any accidents occur. I give consent for the camp staff to treat my child in case of injury or illness. I also understand that any serious violation of camp regulations will result in removal of my child from camp and no refund will be given.

COVID 19- Waiver

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY CHECKING THE BOX ON THE REGISTRATION FORM, AND ACKNOWLEDGE FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT

In consideration of being allowed to participate on behalf of (Coach Encapera Baseball Camp) athletic program and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS (Coach Encapera Baseball Camp) their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I agree to the terms of the COVID 19 Waiver Terms

How did you hear about us?(required)

Search Engine Social Media Returning Camper Friend or Family

Emergency Contact Person During Camp Hours (if different from parent)(required)

Emergency Contact Phone Number(required)

Click Here to pay for Camp AFTER Submitting Form

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