Registration

Step One: Camper Information

Register for

_____ Summer 1 High School Evaluation Camp (June 14, 2010)

_____ Youth Summer Camp June 28-30, 2010 Full Day

_____ Youth Summer Camp June 28-30, 2010 Half Day

_____ Youth Summer Camp July 12-14, 2010 Full Day

_____ Youth Summer Camp July 12-14, 2010 Half Day

_____ Summer 2 High School Evaluation Camp (August 21, 2010)

Name____________________________________________ Age ______

Grade ______ HS_________________________________________

Home Address: _________________________________City, State, Zip: _______________________

Home Phone: __________________________Mobile Phone: _______________________________

E-Mail: _______________________________Parent’s Cell: ________________________________

Emergency Contact: ______________________ Relation: __________________________________

Contacts Phone: _________________________________

Shirt Size (circle one): YS YM YL S M L XL XXL

Step Two: Sign Waiver and Release of Liability

Waiver and Release of Liability

In Consideration of being allowed to participate in any way in the Bearkat Baseball Academy the undersigned:

Agrees that the parent(s), and/or legal guardian(s) will instruct the minor participant that prior to participating he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she should immediately advise his or her coach or supervisor of such condition and refuse to participate.
ACKNOWLEDGES AND FULLY UNDERSTANDS that each participant will be engaging in ACTIVITIES THAT INVOLVE RISK OF SERIOUS INJURY, INCLUDING PERMANENT DISABILITY AND DEATH, and severe social and economic losses which might result not only from their own actions, inactions or negligence, but the action, inaction or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonable foreseeable at this time.
ASSUMES ALL THE FOREGOING RISK AND ACCEPT PERSONAL RESPONSIBILITY FOR THE DAMAGES following such injury, permanent disability or death.
RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the Mark Johnson Baseball Academy CAMP, its affiliated clubs, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as "releases", from any and all liability to each of the undersigned, his or her heirs and next of kin for any and ALL CLAIMS, DEMANDS, LOSSES OR DAMAGES ON ACCOUNT OF INJURY, INCLUDING DEATH AND DAMAGE TO PROPERTY, CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PARTY BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY.

Parent or Guardian Signature _________________________________________________

Relation_______________________________ Date ________________________

Printed Name of Parent or Guardian____________________________________________________________

Printed Name of Participant___________________________________________________________

Address of Participant_______________________________________________________________

Step Three: Return Application/Pay Deposit

Remit Full Payment or $50 Non-Refundable Deposit To:

Mark Johnson Baseball Academy

c/o Jim Blair

927 Elkins Lake

Huntsville, TX 77340

Questions?

Contact Jim Blair, Assistant Coach

Phone: 936.294.4653

E-mail: jimblair@shsu.edu

Website: www.markjohnsonbaseballcamp.com