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CAMPER S NAME: _____________________________________________ STREET ADDRESS: ___________________________________________ PowerPoint Presentation
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CAMPER S NAME: _____________________________________________ STREET ADDRESS: ___________________________________________

CAMPER S NAME: _____________________________________________ STREET ADDRESS: ___________________________________________

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CAMPER S NAME: _____________________________________________ STREET ADDRESS: ___________________________________________

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    1. CAMPERS NAME: _____________________________________________ STREET ADDRESS: ______________________________________________________________ CITY/STATE/ZIP:_______________________________________________ EMAIL ADDRESS:______________________________________________ POSITIONS YOU PLAY:_________________________________________ GRADE: _____ AGE: ____ SCHOOL:______________________________ CAMP SHIRT (circle one) Youth L, Adult S, Adult M, Adult L, Adult XL PARENTS NAME(S):___________________________________________ CONTACT PHONE NUMBERS:___________________________________ EMERGENCY CONTACT NAME & PHONE NUMBER: I hereby authorize the staff at the South County STALLIONS Winter Training Clinic to act for me according to their best judgment in the event of an emergency requiring medical attention and I hereby waive and release the clinic from any liability for any injuries and illness incurred while at the clinic. I have no knowledge of any physical impairment that would affect the participation of my child in the clinic program as outlined in this brochure. Parent Signature: ________________________ Date:________________ Make checks payable to: SCABC - Baseball Mail Registration & Check to: South County Secondary School, 8501 Silverbrook Road; Lorton, Virginia 22079 Attn: Mark Luther Winter Training Clinic - Baseball Winter Training Clinic Sunday, Jan 29th, Feb 5th , Feb 12th (Ages 8-14 / Grades 4-8) Location: South County SS Gym Time: 12:00 2:30pm Fee: $85 (includes camp shirt) $75 additional family members. What to Bring: Wear tennis shoes (no cleats) & Sweatpants or Baseball Pants, Glove, Bat, & Helmet. Bring water bottle. Deadline: Register by January 25, 2012 Space is Limited! Register Early!! Questions: Coach Mark Luther 703-446-1680, Mark.Luther@fcps.edu or Robbie Smith 703-446-1578, Robbie.Smith1@fcps.edu. Additional registration forms can be found at http://www.stallionsports.org/