West plains youth baseball and softball 2013 registration form

WEST PLAINS YOUTH BASEBALL AND SOFTBALL

2013 REGISTRATION FORM

THE WEST PLAINS PARKS AND RECREATION DEPARTMENT WILL OFFER THE NBC “HAP” DUMONT YOUTH BASEBALL PROGRAM FOR BOYS, AND ASA SOFTBALL PROGRAM FOR GIRLS DURING THE 2012 SEASON. ELIGIBLE PLAYERS MUST BE AT LEAST SIX YEARS OLD BY JUNE 1^ST. 13-15 YR OLDS WILL NOT HAVE A DRAFT– WHOLE TEAMS MUST SIGN UP!

THIS FORM AND A $25.00 PLAYER FEE MUST BE TURNED IN BEFORE FRIDAY, APRIL 19^th, 2013

(ANY LATE REGISTRATIONS WILL BE CHARGED A $5.00 LATE FEE AND

PLACED ON A WAITING LIST, AND ADDED TO A TEAM IF SPACE IS AVAILABLE)

THE REGISTRATION FORM AND PLAYER FEE MUST BE TURNED IN BY APRIL 19^th, AT THE WEST PLAINS PARK OFFICE.

FOR INFORMATION ABOUT THE PROGRAM OR REGISTRATION, CALL THE WEST PLAINS PARK OFFICE AT 417-256-7304 OR EMAIL US AT [e-mail]

THERE IS NO FOOD OR DRINKS ALLOWED IN THE HILBURN COMPLEX.

PLAYER REGISTRATION

NAME:____________________________DATE OF BIRTH:________________BOY:____GIRL:_____
CIRCLE AGE BY JUNE 1^ST 6 7 8 9 10 11 12 CURRENT GRADE:_________
ADDRESS:_______________________________________________________________________________
NAME OF PARENT/GUARDIAN:__________________________________________________________
HOME PHONE:_________________________ CELL PHONE:_____________________

MY CHILD HAS PERMISSION TO PARTICIPATE IN THE YOUTH BASEBALL/SOFTBALL PROGRAM, AND I WILL NOT HOLD ANYONE ASSOCIATED WITH THE PROGRAM RESPONSIBLE IN CASE OF ACCIDENT OR INJURY INCURRED DURING PLAY OR OTHER ACTIVITY CONNECTED TO THIS PROGRAM.

PARENT/GUARDIAN SIGNATURE:_________________________________________________________

NOTE: (REGISTRATION NOT ACCEPTED WITHOUT SIGNATURE)

VOLUNTEER INFORMATION

COMPLETE THE FOLLOWING INFORMATION IF YOU ARE ABLE TO HELP SUPPORT THE WEST PLAINS PARKS AND RECREATION PROGRAM.

NAME:___________________________________________________________________________________

HOME PHONE:___________________________BUSINESS PHONE:______________________________

ADDRESS: (IF DIFFERENT THAN ABOVE):________________________________________________
_____ I CAN COACH A TEAM AGE GROUP:________________ _____ I CAN ASSIST A TEAM
_____ I CAN SPONSOR A TEAM (OR PROVIDE A TEAM SPONSOR)
SPONSOR NAME:___________________________________________PHONE:_________________________________
ADDRESS:_________________________________________________NAME:__________________________________
______ I AM INTERESTED IN CONTRIBUTING TO THE EQUIPMENT REPLACEMENT FUND.
______ I AM INTERESTED IN UMPIRING OR SCOREKEEPING AGE GROUP: ________________