Winter Indoor Clinic Registration
Child’s Name*__________________________ Tel #: Home*________________________
Cell*__________________________
Parent/Guardian
Name*_______________________________________________________
Address*_______________________________ Town*______________________________
Child’s D.O.B*_________________________ Grade*____________ Age*____________
(Must be 4
years of age on or before 9/30 of last year)
Boy:________
Girl:___________ E-Mail
Address*___________________________
Did you attend last year? Y N Traveling Player? Y N
*Required
Information
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SHIRT SIZE
YS YM YL AS
First Child: $25.00
Each additional child: $20.00
I HEREBY GRANT
PERMISSION FOR MY CHILD, NAMED ABOVE, TO PARTICIPATE IN THE
____________________ _________________________________________
Dated: Signature of Parent/Guardian