2012 Online Spring Registration Form
Please click on the Submit button to submit the form details.
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indicates required fields
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Childs Name:
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Childs Address:
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Childs Age as of April 30th, 2012:
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Date of Birth:
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Male / Female:
Male
Female
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Parent or Guardian Name:
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Phone Number:
Cell Phone Number:
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Email Address:
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Does child have any limitations:
Yes
No
If Yes, please explain:
Anything we can do to help?:
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Family Doctor's Name:
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Doctor's Phone Number:
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Emergency Contact:
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Emergency Contact Phone Number:
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Players Uniform Shirt Size:
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult 2X-Large
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Players Uniform Pant Size:
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult 2X-Large
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Playing any other sports/activities:
I accept
I do not accept
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Authorization for child's photo to be published:
Yes
No
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I understand this is in lieu of my signature:
Yes
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Parent Occupation (Optional):
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How many years has your child been in the JBA:
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Any special requests? (Not guaranteed):
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PLEASE MAIL ALL PAYMENTS TO:
Registration Fee $45.00
Candy $50.00 OR candy buyout $25.00
Work Bond Fee $75.00 (SEPERATE CHECK PLEASE and WILL BE DEPOSITED)
Player IS NOT considered registered UNTIL ALL payments are received.
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2012 Registration Fees & Requirements:
ALL registration fees are due at time of submittal.
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Please note:
ALL payments must be received to complete registration process.
Please click on the Submit button to submit the form details.
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