EDUCATIONAL

 LEADERSHIP

   SPEAKER   

                                              COACH TOM GARGIULO’S

                                   YOUTH BASEBALL LEADERSHIP CAMP - 2021

Where: @ Nutley Parks & Recreation      Address:   44 Park Ave., Nutley, NJ 07110

When:  Monday to Friday / 9am – 1pm

Sessions:    (1.) JUNE 28 - JULY 2       (2.)  JULY 12-16         (3.)  JULY 19-23        (4.)  JULY 26-30  

Who:  Players age 5-13

Contact & Follow: 

Email: [email protected]                        Website:  coachtomleadership.com

Instagram: coachtomleadership                                    Twitter: @coachtgargiulo

KEEP ABOVE INFO & MAIL (or Email)  THE REGISTRATION FORM

REGISTRATION FORM – 2021

 “CIRCLE” CAMP DATES 

 I.  6/28-7/2          II.  7/12-16          III.  7/19-23         IV.  7/26-30

CAMPER NAME:______________________________________________________________AGE: _________

* EMAIL: ________________________________________________________________________________

MEDICAL RESTRICTIONS:___________________________________________________________________

SCHOOL:________________________________________________  Entering Grade_________

(CIRCLE)  T-SHIRT SIZE:         YOUTH:    S     M     L            ADULT:    S     M     L     XL

ADDRESS:_______________________________________________________CITY_____________________

PARENT/GUARDIAN________________________________________________________________________

EMERGENCY: NAME & NUMBER_______________________________________________________________

WAIVER 2021:  I hereby request that the child named below be admitted to Division I Sports Camp, LLC, and authorize the directors to act for me according to their best judgment in any emergency medical situations, other than that provided by the camp, for which I will pay. I will not hold Division I Sports Camp, LLC or any camp representative responsible for any injury or loss incurred by my child or family.

* SIGN & DATE  X_______________________________________________________Date________________

Cost:  $250

Venmo:   @Tom-Gargiulo-1

By check, make payable to:

DIVISION I SPORTS CAMP, LLC

Mail registration & check to:

COACH TOM GARGIULO

8 SARGENT ST. #1

NUTLEY, NJ 07110