Saturday, June 25, 2011

9:00 am to 3:00 pm

Troy High School Baseball Field

$40.00 Includes: training, lunch and a camp t-shirt

Please complete the registration form that follows and send

to Troy High School, along with your check, no later than

FRIDAY, JUNE 17, to lock in your reservation.

(Please make checks payable to James Wernke Foundation)

Please fill out and send to:

Troy High School

c/o Tiffany Robinson

2200 E. Dorothy Lane, Fullerton, CA 92381

Name of Student: ____________________________________________________________

T-Shirt Size (Circle One): Youth – S M L XL Adult – XS S M L XL

School: _____________________________________________________________________

Grade for 2011-2012 school year: ____________________________________________

Name of Parent or Guardian: _________________________________________________

Home Phone Number: ________________________ Cell: _________________________

Mailing Address: ____________________________________________________________

______________________________________________________________________________

Email: _______________________________________________________________________

Any Health/Injuries we need to know about?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Position(s) they play in baseball: _____________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Years of experience (None are needed for camp): ____________________________

I ALLOW MY CHILD TO PLAY BASEBALL AT HIS/HER OWN RISK. ANY TYPE OF INJURY

AS A RESULT OF PLAYING BASEBALL IS STRICTLY UNDER THE INDIVIDUAL’S

RESPONSIBILITY.

______________________________________________________________________________

(PARENT SIGNATURE) (DATE)