2011 Bronco Registration Form

MIDWAY BASEBALL ASSN. A NON-PROFIT ORGANIZATION

Registration Form for Bronco Ages 11-12 by April 30, 2011

LAST NAME:	PHONE #:
ADDRESS:	ZIP CODE:
E-MAIL ADDRESS:

CHILD NAME	M/F	BIRTH DATE	MIDWAY USE ONLY

Minimum deposit of $50 per child. There will be a late fee of $50.00 if fees are not paid by March 6, 2011. ALL FEES ARE NON-REFUNDABLE.

Bronco Registration # of children ___________ at $170.00 ________________

Less Returning Credit # of children ___________ at $ 10.00 ________________

Family Obligation Fee ________________

Will automatically forfeit obligation fee YES or NO

TOTAL REGISTRATION FEES _______________

MONEY PAID: Cash _______________ Check# _____________ _______________ BALANCE DUE: _______________

Proof of Age checked _____ Birth Certificate _____ State ID _____ Passport

FALSIFICATION OF AGE OR REFUSAL TO PLAY FOR MANAGER WHO DRAFTS YOUR CHILD WILL RESULT IN FORFEITURE OF FEES AND IMMEDIATE EXPULSION FROM LEAGUE. I AGREE TO THESE TERMS.

SIGNATURE OF PARENT/GUARDIAN __________________________________________________ DATE __________________