CMCC Softball February Clinic

Student/Participant Information

I am registering a participant for the:(Required)

Youth Clinic (Grades 3-6)

Middle & High School Clinic (Grades 7-12)

Participant First Name(Required)

Participant Middle Initial

Participant Last Name(Required)

Date of Birth(Required)

Participant Gender(Required)

Participant is on track to graduate in: (enter graduation year)(Required)

Participant Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Participant Cell Phone (Enter N/A if none)(Required)

Participant Email (Enter N/A if none)(Required)

I need to register another participant:(Required)

No

Yes

Participant First Name(Required)

Participant Last Name(Required)

Date of Birth(Required)

Participant Gender(Required)

Participant is on track to graduate in: (enter graduation year)(Required)

Participant Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

I give permission for my child to be photographed while on campus. I understand the photos will be used for marketing purposes only.

I give permission for my child to be photographed while on campus. I understand the photos will be used for marketing purposes.

Yes

No

Health Information

Enter "NONE" if the field is not applicable.

Allergies(Required)

Medications(Required)

List any current condition and any recent surgeries, hospitalizations illnesses, or injuries(Required)

Health Insurance

Health Insurance Provider(Required)

Policy Number(Required)

Emergency Contact Information

Parent/Guardian Name(Required)

First Last

Parent/Guardian Cell Phone(Required)

Parent/Guardian Email(Required)

Choose from one of the options below:(Required)

Emergency Contact Information is the same as Parent/Guardian already listed

Emergency Contact Information is DIFFERENT than Parent/Guardian already listed.

Emergency Contact Information(Required)

First Last

Emergency Contact Phone(Required)

Emergency Contact Email(Required)

Session Selection

Youth Clinic Session Selection(Required)

Session 1

Youth Clinic Additional Participant(Required)

Session 1

Middle & High School Clinic Session Selection(Required)

All Sessions

Pitching and Catching

Hitting and Fielding

Live Hitting & Scrimmage

Total Registration Cost

Payment Method(Required)

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

CMCC Softball February Clinic

CMCC Softball Prospect Camp February

Student/Participant Information

Health Information

Emergency Contact Information

Session Selection