MIDWAY BASEBALL ASSN.        A NON-PROFIT ORGANIZATION

Registration Form for Colt Ages 15-16 by April 30, 2012

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

CHILD NAME	M/F	BIRTH DATE	MIDWAY USE ONLY

Minimum deposit of $75 per child.  There will be a late fee of $50.00 if fees are not paid by May 26, 2012.                                                    ALL FEES ARE NON-REFUNDABLE.

Colt Registration                    # of children ___________                                                              at $250.00                ________________

Less Vest Credit                                                                                                                              at $  40.00                ________________

                                                                                                                                                      

Vest # _______________    Vest # _______________    Vest # _______________   

 

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 __________________

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