Baseball Registration Form

10 Romans Road, Hyde Park, NY 12538 * (845) 229-9150 * Fax: (845) 229-1074 Contact Us

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Registration Form

Name:
Age:
Gender (M/F):
Birthdate:
Parent's Name:
Phone Number:
Address:
Town:
Zip Code:
Would you like to be notified by email? Please provide email address:
MEDICAL AND INSURANCE INFORMATION
Medical Insurance:
Doctor's Name
Doctor's Practice:
Phone Number:
Group #:
Players ID #:
Primary Member Name:

In case of medical emergency, I understand every effort will be made to contact parents or guardian of player. In the event I cannot be reached, I hereby give permission to the physician selected by the coaching staff to secure proper treatment for my child.

We encourage parents to be involved under the direction of your child’s coach.

(If registration is done through this online form, signature will be required at the first practice.)

Parents Initials:

Fee:
Church members: $20 per child, 3 or more $50.
Non-Church members: $40 per child, 3 or more $100.
A $15 late fee after March 4, 2012.

Please make checks payable to: Hyde Park Baptist Church

After electronically submitting this form, and to secure a spot on the league:

PLEASE REMIT PAYMENT BY MAIL to:

Hyde Park Baptist Church
ATTN: Pastor Nargi
10 Romans Road
Hyde Park, New York 12538

Any questions please contact Pastor Nargi or call (845) 229-9150.

Included with registration, is a discount coupon from Modell’s. The coupon must be used from March 23 – April 20, 2012. After our organization reaches $500 in sales we will receive 5% back. The 5% we receive will go to the Sports Ministry Budget. Click here for the printable coupon.