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Winter Baseball Camps
Story Links
Dec. 13, 1999
Complete and mail application below along with a check for $85 or $110, made out to the Steve Heon Baseball Camps, to:
Winter Baseball Camps
University Hall
P.O. Box 3785
Charlottesville, VA 22903
Name__________________________________ Last, First (Nickname)Social Security_______________________Address_______________________________City__________________________________State___________Zip___________________Phone (H)_____________________________ (O)_____________________________Age________________________Birthdate__________________Grade______________________School_____________________HeightWeight_______________Position(s)________________B/T________________________
Circle the session you wish to attend:
December 18, 19 or December 27, 28
Medical Emergency Information:Father?s Name____________________Phone (H)________________________ (O)________________________Mother?s Name____________________Phone (H)________________________ (O)________________________Legal Guardian___________________Phone(H)_________________________ (O)_________________________Doctor?s Name____________________Phone____________________________Insurance________________________Policy #_________________________
Please list any medications taken, previousinjuries, diseases, allergies, etc.__________________________________________________________________________________________Presently taking medications?__________________________________________________________________________________________Any physical limitations?__________________________________________________________________________________________
Parent?s Statement:
I hereby give my permission for a qualified physician and/or hospital emergency personnel to administer necessary medical attention, or camp staff to administer necessary first aid in case of injury. I also understand that neither the University of Virginia, Steve Heon Baseball Camps, the camp staff nor anyone connected with the camp will assume any responsibility for accidents, medical or dental, or other expenses incurred as a result of accidents during camp.
_________________________________ ___________Signature of Parent or Guardian Date