2017 Play Ball Winter Camp Registration
Name: _____________________________________________________________ Grade Level: _________ Age: _______
School: _____________________________________ Summer Organization: _____________________________________
Position 1: ________ Position 2: ________ Position 3: ________
Field Size: (circle one)
46-60
50-70
60-90
Street Address: _____________________________________ City: _____________________ State: _____ Zip: _________
Parent/Guardian Names: ____________________________________ Email: _____________________________________
Phone #: (________) _______________________
Cell #: (________) _________________________
Emergency Contact: __________________________ Emergency #: (________) _________________________
Payment: $129 total for all 4 dates (8 hours)
CASH
WHEN:
Play Ball Baseball Winter Camp
WHERE:
Nation 9 Sports Academy
CHECK # _________
Grades 5-8
CREDIT TRANSACTION
SAT 2/4, 2/11, 2/18, 2/25
12:00–2:00 pm
115 Lower Morrisville Rd
Levittown, Pa 19054
(Near Bucks Gymnastics II, 225 Lower Morrisville Rd)
COST:
$129 Per Camper for all 4 dates (8 total hours)
Make Checks Payable to:
Joe Pesci*
*Accepted camper fee includes 25% non-refundable deposit. Full camp fee becomes non-refundable
on January 28th. You will receive notifcation of camp status upon receipt of your application and
payment. Full fee will be refunded if camp is full when your application is received.
Mail application and payment to:
Joe Pesci – Play Ball Baseball Training
504 Warwick Circle
Fairless Hills, Pa 19030
LIMITED SPACE AVAILABLE SO SEND YOUR APPLICATION IN TODAY!
Insurance Waiver
I, signed as official parent or guardian of the above named athlete, certify my child to be in good health and give my permission for
their participation in the baseball camp. I authorize all emergency and medical treatment, which may be needed in the event of an
injury. I also understand that primary insurance coverage is my own responsibility through my individual family plan. I agree to
defend, indemnify and hold harmless Joe Pesci, Play Ball Baseball Camps, Nation 9 Sports Academy, Pennsbury School District and
all instructional personnel in the event of injury to my child:
________________________________________
Parent/Guardian Print name
______________________________
Relationship to child
________________________________________
Parent/guardian Signature
______________________________
Date
Insurance Disclaimer for Individual Players
DISCLAIMER: NATION9 SPORTS ACADEMY, INC. IS NOT RESPONSIBLE FOR ANY INJURY (OR LOSS OF
PROPERTY) TO ANY PERSON SUFFERED WHILE PLAYING, PRACTICING OR IN ANY OTHER WAY INVOLVED
IN NATION9 SPORTS ACADEMY FOR ANY REASON WHATSOEVER, INCLUDING ORDINARY NEGLIGENCE ON
THE PART OF THE NATION9 SPORTS ACADEMY OR ITS AGENTS, EMPLOYEES, SPONSORS, VOLUNTEERS,
THE OWNERS AND LESSORS OF THE PREMISES AND ALL OTHERS WHO ARE INVOLVED.
In consideration of my being allowed to participate in any way in the Nation9 Sports Academy related events
and activities I hereby release and covenant not-to-sue Nation9 Sports Academy and any of their employees,
servants, independent contractors, instructors or agents, from any and all present and future claims resulting
from ordinary negligence on the part of the Nation9 Sports Academy, or others listed for property damage,
personal injury or wrongful death, arising as a result of my engaging in or receiving instruction at the Nation9
Sports Academy, programs and activities incidental thereto, wherever, whenever, or however the same may
occur. I hereby voluntarily waive any and all claims resulting from ordinary negligence, both present and
future, that may be made by me, my family, estate, heirs, or assigns. Further, I am aware that baseball,
softball, soccer, or lacrosse (or other sport) is a vigorous team sport at times involving severe cardiovascular
stress and violent physical contact. I understand that baseball, softball, soccer, or lacrosse (or other sport)
involves certain risk, including but not limited to death, serious neck and spinal injuries resulting in complete
or partial paralysis, brain damage and serious injury to virtually all bones, joints, muscles and internal organs,
and that equipment provided for my protection may be inadequate to prevent serious injury. I further
understand that baseball, softball, soccer, or lacrosse (or other sport) involves a particularly high risk of
ankle, knee, head, and neck injury. In addition, I understand that participation at Nation9 Sports Academy
involves activities incidental thereto, including but not limited to, travel to and from the site activity,
participation at sites that may be remote from available medical assistance, and possible reckless conduct of
other participants. I am voluntarily participating in this activity with knowledge of the danger involved and
hereby agree to accept any and all inherent risks of property damage, personal injury, or death. I further
agree to indemnify and hold harmless the Nation9 Sports Academy and others listed for any and all claims
arising as a result of my engaging in or receiving instruction in the Nation9 Sports Academy activities or any
activities incidental thereto, wherever, whenever, or however the same may occur. I have private insurance
coverage for the participant and will list the carrier and policy number below. In absence of this information, I
assume all liability for such expenses. I understand that this waiver is intended to be as broad and inclusive as
permitted by the laws of Pennsylvania and agree that if any portion is held invalid the remainder of the
waiver will continue in full legal force and effect. I further agree that the venue for any legal proceeding shall
be in the state of Pennsylvania.
Release Waiver
The following signature guarantees Nation9 Sports Academy that, I have read and fully understand the
Insurance Disclaimer and agree to the terms and conditions stated.
Player’s Name: ___________________________________________________________________________________
Address:______________________________________City:________________St:____Zip:________
Phone Number:___________________Parents Email:______________________________________
Parent or Guardian’s Signature: __________________________________________ Date: _________
Parent or Guardian’s Name (Print) _______________________________________________________
Health Insurance Carrier: _____________________________________Policy Number: ____________