REGISTRATION FORM
[Submit online or print out and mail in]

Name  Age   Grade   Primary Position

Address  City State   Zip

Phone   Email    

Coach   Coach's E-mail  

Years of Experience    Level of Experience   Beginner Intermediate Advanced   

Please check the session(s) you will be attending:

Fielding 10am-12:15pm                           Offense/Hitting 1:00-4:00pm                              Pitching 4:00-6:00pm

T-Shirt Size Youth Small Youth Medium Youth Large Small Medium Large X-Large Must be pre-registered and paid by January 30th to receive free t-shirt

Payment Options:
Check (Make payable to LHUF Softball & send to: 228D Thomas Fieldhouse, Lock Haven, PA  17745)

Credit Card           Visa         MasterCard     Discover

Credit Card #   Expiration Date:   Sec Code: (3 digit # on back)

Name on Card
 

Liability Release: By checking the box below, I am permitting the above named minor to participate in the sports clinic sponsored by Lock Haven University. I do hereby agree to release, discharge and hold harmless Lock Haven University, their owners, agents and employees of and from all causes, liabilities, damages, claims or demands whatsoever on account of injury or accident involving the said minor arising out of the minor's attendance at the sport clinic or in the course of competition and/or activities held in connection with the sport clinic.

I agree

If you have any questions, please call or e-mail Assistant Coach Danielle Fraser at:
(570) 484-2574 or dfraser@lhup.edu