Registration Form - Fall Baseball & Indoor Winter Clinics

REGISTRATION FORM

*Name:
*DOB (Date of Birth):
*Medicare Card Number:
*Sex:          
*Address
*City:          

*Postal Code
*Parent's Name (1)
Parent's Name (2)
*Cell Phone (Parent 1)
Cell Phone (Parent 2)
Phone Number (Home)
Phone Number (Work)
*Email Address
*Do you consent to allowing DABA to use your child's photo in DABA promotional material and/or publications (ie.: Website, Facebook, Instagram, etc.)?
Yes No

Choose your program:

PROGRAM COST
 
$

AGREEMENT

I, the parent or guardian of the above-named registrant, hereby give my approval to his or her participation in the DABA program. I agree that players will be assigned to groups at the discretion of DABA. I will assume all risks and hazards to the registrant including transportation to and from the activities, whether on a baseball field or elsewhere. I do hereby waive, release, absolve, indemnify and agree to hold harmless DABA and all its volunteers, officials and affiliates for claims arising out of an injury to the registrant, whether the result of negligence or for any other cause.



Payment Method:

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