Online Registration Form - Vernon and District Baseball Association

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2010 ONLINE Registration Form - Vernon & District Baseball Association
*Please fill in a new form for each youth that you are registering*
You will be asked if you would like to register again after making online payments as well.

Player Information:

First Name

Last Name

Birth date: (MM/DD/YY)

Care Card#

Gender
M F

Any Health Care Issues VDBA should be aware of

Legal Guardian/Parent: Phone

First Name

Last Name

Address

City

Postal Code

Cell

Email Address

Retype Email Address

Alternate Contact: Phone

First Name

Last Name

Relationship to Player

VDBA Information: Registering for Division

Played last season? Yes No

Registration Fees for 2010
Division	Birth Year	Early Registration Fee	Fee After March 1st
Rally Cap	2003-2004	$60	$80
Tadpole	2001 - 2002	$85	$105
Mosquito	1999 - 2000	$110	$130
Pee Wee	1997 - 1998	$115	$135
Bantam	1995 - 1996	$130	$150
Midget	1992 - 1994	$130	$150

Online Payment - Paypal Account Online Payment - Credit Card Amount $:

REGISTRATION DEADLINE: March 15, 2010
Any registrations or inquiries after deadline will be put on a waitlist
and notified if space is available in the requested division.

SPECIAL REQUESTS:
For Special Requests, please contact the division director.
Click here for Division Director email addresses.

Refund Policy:
50% refund up to April 15th and NO REFUND after April 15th, 2010 unless for medical reasons and must be accompanied by a doctor's note.

Can you help? Name: Phone #

Coach Assistant Coach Team Manager VDBA Sponsor Scorekeeping
Umpire Opening Day/Fundraising other:

ALL PLAYERS MUST WEAR A CSA APPROVED BATTING HELMET, ATHLETIC PROTECTOR
AND GREY BASEBALL SLIDING PANTS (no longer provided by VDBA).

I AGREE that the Vernon and District Baseball Association is NOT responsible for any injuries sustained by the above child While taking part and traveling to and from the above activity.
I agree that the VDBA may publish photographs or other media images taken of my child.YesNo

Date Signed by Parent/Guardian (Acknowledged By):

STOP - PLEASE PRINT THIS COPY FOR YOUR RECORD BEFORE YOU CLICK SUBMIT!
(Click FILE and then PRINT from your Internet Browser or Right click -select PRINT using your mouse)