Child’s Name: ___________________________________________________Age:_________________

Address:___________________________________City_________________________ Zip:__________

Telephone:_________________________________Cell Phone (Optional)__________________________

Please enroll the undersigned. The applicant is in good health and able to participate in the physical activity of a vigorous
sports program. In the event of illness or medical care, the clinic management and/or staff has my permission to provide
basic medical care.
Insurance Statement: We are aware of the risks inherent with the activities my child will be participating in and willingly
assume the risk of injury. We release the Manchester Silkworms and the clinic staff from all claims.

Parent or Legal Guardian’s name:____________________________________________________________

Signature of Parent or Legal Guardian:________________________________________________________

Prior to camp, a registration/medical information form will need to be on file for each camper. This form can be
downloaded from the Manchester Silkworms website, or filled out the day of registration. This form only needs
to be filled out once if your child is attending multiple camps.

I would also like to be notified by the Silkworms e-mail of future Silkworms activities. The Silkworms DO NOT
share any personal or electronic information with any outside sources.

e-mail address:_______________________________________________________________________________

Please Mail this form along with your payment of $100.00 (per camper) to:

Baseball Camp
Manchester Silkworms
PO Box 1576
Manchester CT 06045-1576