Weiss Baseball Camps

Camper Information

Camper First Name *
 
Camper Last Name *
 
Grade *
 
Age
 
School *
 
Email Address *
 
Camper Shirt Size *
 
Camper Position Played *
 

Household / Adult Primary Contact

Relationship to Participant: *
 Self
 Mother
 Father
 Guardian
 Other
First Name *
 
Last Name *
 
Address 1 *
 
Address 2
 
City *
 
State *
 
Zip *
 
Phone *
 
Alternate Phone
 
Insurance (Company, Phone #, Insured's Name, Account #) *
 
 
 
 
 
 
 
Emergency Contact's Name and Phone Number *
 
 
 
 
 
 
 
I hereby authorize the staff at Weiss Baseball Summer Camps toact for me according to their best judgment in the event of an emergency requiring medical attention and I hereby waive and release the camp from any liability for any injuries and illness incurred while at camp. I have no knowledge of any physical impairment that would affect the participation in the camp program as outlined in this brochure.
Sign and Date *
 
 
 
 
 
Camp Pricing *
 Camp Fees ($250.00)
Aftercare will be $20/hour. Please pay total due at end of the week. If paying for care the entire week, please click below to include in total bill. (Paying for the week upfront will save you $100 dollars in care over the five days)
 Week of Aftercare ($100.00)
Make checks payable to: Brent WeissMail Registration and Check to:Brent Weiss5517 Sedgwick LaneSpringfield, VA 22151