Player Information

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Shirt Size *

Date of Birth *

School Name *

Year of Graduation *

Positions *

Level of Experience *

Travel Team

Family Information

Home Phone *

Family Email Address *

Father's Name *

Father's Cell Phone *

Mother's Name *

Mother's Cell Phone *

CAMP WAIVER

Physicians Name and Number *

Insurance Company and Policy Number *

In enrolling in a Willemssen Sports Training event, the participant understands that he/she is attending the programs and using the facilities does so at his/her own risk. Willemssen Sports Training and its owners, employees or agents, shall not be liable for any damage whatsoever arising from any personal injury or property loss sustained by participant. Participants and parents assume full responsibility for all injuries and damages which occur in or about any programs. He/She does hereby fully and forever release discharged hold harmless Willemssen Sports Training, all associated facilities and its owner, employees, and agents from any and all claims, demands, damages or rights of action, present or future resulting from any person’s participation in any programs or use of a facility. Consent: I the parent or guardian/participant do hereby grant authority to the staff at a Willemssen Sports Training event to render a judgement concerning medical assistance or hospital care in the event of an accident or illness during my absence. I do hereby authorize Willemssen Sports Training and its assigns to utilize any and all photographs, pictures or other likeness of me or anyone assigned guardianship to me, as they deem appropriate in its promotional materials or team films. *

I ACCEPT

Camp Fee--$335

Click On Camp Fee Then Continue For Payment Options *

$335.00

Questions? Please contact Suzy Willemssen

suzy@suzywillemssen.org

703-298-8706

GO FASTPITCH!