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linedriveathleticsnc@gmail.com
704.615.0376
Line Drive Athletics
Softball and Baseball Training
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Summer Camps
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Private Lessons
About
Home
Summer Camps
Clinics
Private Lessons
About
Registration Form
Please complete our online registration form below.
You may also make a payment at the end of the form, to reserve your child’s spot.
Player Information
Player Name
*
First
Middle
Last
Gender
*
Male
Female
School Name
Grade
*
Birth Date
*
Date Format: MM slash DD slash YYYY
Age
*
Parent/Guardian Contact Information
Parent/Guardian #1
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Daytime Phone
Cell Phone
*
Email
*
Enter Email
Confirm Email
Parent/Guardian #2
First
Last
Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Daytime Phone
Cell Phone
Email
Enter Email
Confirm Email
Alternate Pickup/Release Information
Name
First
Last
Home Phone
Daytime Phone
Cell Phone
Email
Enter Email
Confirm Email
Relation to child
Medical Release Information
Insurance Information
Name of Health Insurance Provider
*
Policy Number
*
Primary Physician
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Physician Phone
*
Hospital Preference
*
Does your child have any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures).
*
Yes
No
Medical Problem
*
Required Treatment
*
Should paramedic by called?
*
Yes
No
Medical Problem
Required Treatment
Should paramedic by called?
Yes
No
Consent Acknowlegements
Medical Emergency Consent
*
I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill.
Medical Expenses Consent
*
I understand that the Line Drive Athletics Softball Camp will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.
Photo Release Consent
*
I hereby give permission for my child to be photographed during the Line Drive Athletics Softball Camp. I understand the photos may be used for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed.
Terms of Agreement
*
Line Drive Athletics Softball Camp and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders. Children's’ photos and quotes may be used for publicity purposes. In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician).
Date
Date Format: MM slash DD slash YYYY
Signature
*
Printed Name of Parent/Guardian
*
First
Last
Payment
How would you like to pay?
*
Mail Check
Pay Online
Please select the training you would like to register for:
*
Due to COVID-19, ALL Summer Camps are Closed
Summer Camp
Clinic
Private Lessons
YOUTH - T-Shirt size
Small
Medium
Large
Extra Large
ADULT - T-Shirt size
Small
Medium
Large
Extra Large
Which Camp will this child be attending?
*
$199.99 - Beginner Camp
$249.99 - Advanced Summer Camp
BEGINNER (recommended for ages 5-9 or players of all ages with limited experience)
ADVANCED (recommended for ages 10-14 or players of all ages with 3+ years experience)
Private Lessons
*
$50.00 - 1 Player
$70.00 - 2 Players
$100.00 - 3 Players
45 minutes
Which Clinic would you like to pay for?
*
$80.00 - Winter Clinic - 1 day
$150.00 - Winter Clinic - 2 days
Which day would you like for the Winter Clinic training?
*
January 10, 2021
January 17, 2021
Please mail your payment to:
Line Drive Athletics
2338 Big Pine Dr
Matthews, NC 28105
Please write camper's name on check.
Credit Card
*
American Express
Discover
MasterCard
Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
Expiration Date
Security Code
Cardholder Name
Coupon
Total
$0.00
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