Tuesday June 16, 2015 9:00AM-4:00PM

Tuesday June 16, 2015
9:00AM-4:00PM
Limited to first 40 campers!!!
All Skills (Hitting, Fielding, Throwing, and Running)
Ages: 9th grade & Up
Cost: $50.00 Lunch Included
Location: UT Tyler Ballpark/ UT Tyler Campus
ALL REGISTRATION MUST BE SENT TO WWYLY@UTTYLER.EDU
Participant’s Name: ______________________________________ High School: ___________________________
Email: ____________________________________________________ Select Team: __________________________
Circle All That Apply:
RH hitter
LH hitter
LH slapper
Parent’s Names: __________________________________________Address:______________________________________
City/State/ ZIP: __________________________________________________ Phone: ______________________________
Primary Position: ____________ Secondary Position: ______________ Grad Year: _________________________
Emergency Contact: ________________________________________ Phone: _________________________
Medical Release and Photography Release Statements
These statements must be signed by parent/guardian before the child can participate in camp.
I certify that my child is physically fit for all softball camp activities and grant permission in case of injury, accident or illness
that she be treated by a licensed physician. Furthermore, I release the University of Texas at Tyler, in officers, directors and all
associated with the camp from any and all liability for personal injury arising out of the applicant’s participation in the camp.
Parent/Guardian Signature__________________________________________________ Date: _________________________
I agree to allow the participant listed above to participate in the photo opportunities available at the University of Texas at
Tyler and give UT Tyler permission to use photos of my child in any advertising or marketing promotions (print, electronic,
outdoor advertising, faculty presentations and publications.) All prints, slides and digital images belong to UT Tyler solely and
completely.
Parent/Guardian Signature__________________________________________________ Date:_________________________
Credit Card Payment: Amount $50
Name on Card:______________________________________ Type of Credit Card:____________________________________
Credit Card Number: _________________________________________________ Expiration Date: _______________________
Security Code: ________________ Signature of Card Holder:______________________________________
Cards will not be charged until 72 hours prior to camp date to assure no rain outs or refunds.
IF YOU DO NOT RECEIVE A CONFIRMATION EMAIL WITHIN 72 HOURS PLEASE RESEND THIS FORM.
FOR MORE INFORMATION CALL:UT TYLER SOFTBALL 903-565-5820