Baseball UPA DI 121114.indd

_______________________________________
Name
WHO
I hereby approve my child’s participation in
the Baseball U PA Baseball/Softball Camp,
Boys and girls age 6 to 14
W H AT
tHitting Instruction
tPitching Instruction
tFielding Instruction
tBase Running Instruction
may affect my child’s ability to safely partici-
_______________________________________
Phone
a u t h o r i z at i o n
_____________________________________
Family Physician
_____________________________________
Physician’s Phone
_____________________________________
For up to the minute updates please visit:
facebook.com/baseballUpa
Make up sessions will be held as double
sessions the following day.
Questions? E-mail:
[email protected]
_____________________________________
Special Medical Conditions
_____________________________________
Insurance Co./Policy #
X
_____________________________________
Parent/Guardian Signature
INSTRUCTORS
Brian Felkowski
2XWÀHOG&RDFK8QLYHUVLW\RI6FUDQWRQ
Jamie Higgins
Head Coach, Scranton HS
Matt Fidati
Asst. Coach, West Scranton HS
Head Coach, Baseball U PA 17U Orange
Bill Zalewski
Head Coach, Abington Heights HS
Joe Ross
Head Coach, Scranton Prep HS
Mike Guy
Assistant Coach, University of Scranton
Head Coach, Baseball U PA 17U
Brian Minich
Owner, Baseball U PA
17 Pen y Bryn Drive, Scranton, PA 18505
baseballUpa.com
Paul Zaffuto
Head Coach, Pittston Area HS
r e g i s t r at i o n
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Contact’s Phone
Rob Lemoncelli
Asst. Coach, Pittston Area HS
I N f o r m at i o n
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Emergency Contact
Todd Peters
Head Coach, Lackawanna Trail HS
† Yes I’d like the lunch
Scranton Miners Baseball
17 Pen y Bryn Drive
Scranton, PA 18505
authorize you to contact:
Chris Pensak
Head Coach, Lackawanna College
Options include:
Chicken Fingers
Hot Dogs
Hamburgers
Cheeseburgers
Fries and Pretzels
Camp tuition must accompany application.
Please make checks payable to:
cal emergency arise. If I am not available, I
Jerry Davis
Head Coach, Marywood University
Lunch for the week $25
Lunches will include a choice
of two options and drink
daily.
_______________________________________
Please indicate if you want to be
partnered with any other camper
contact me immediately should any medi-
Rich Moraski
Asst. Coach, Abington Heights HS
LUNCH OPTION
_______________________________________
Grade Entering
Baseball U PA Baseball/Softball Camp will
Todd Hiller
Hitting Coach, Lackawanna College
T Shirt Size (circle one)
Youth SM MD LG
Adult SM MD LG XL
_______________________________________
Age
with any medical emergencies occurring at
(UQLH*ULIÀV
Head Coach, Mt. View HS
Head Coach, Baseball U PA 16U
FREE T-SHIRT INCLUDED
_______________________________________
Emergency Phone
be responsible for all payments associated
Chris Ortiz
Head Coach, Western Wayne HS
Head Coach, Baseball U PA 16U
$150 per camper
Siblings $125
Baseball U PA members $125
_______________________________________
Email
pate in all activities. I understand that I will
Trevor Tellip
Asst. Coach, Lakeland HS
Head Coach, Baseball U PA 15U
COST
cal attention. I know of no health issues that
Justin Stevens
Pitching Coach, Abington Heights HS
Pitching Coach, Baseball U PA 17U
East Scranton Baseball Complex
Corner of Ash Street & Richter Avenue
Scranton, PA 18510
judgement in an emergency requiring medi-
_______________________________________
Address
Max Mueller
Former Pitcher, East Stroudsburg University
Asst. Coach, Baseball U PA 17U
WHERE
able to participate. I hereby authorize that
the staff to act for me according to their best
WHEN
Monday, July 27 - Friday, July 31, 2015
9:00AM to 12:30PM
and certify that s/he is in good health and
_______________________________________
Parent’s Name