2010 Player Registration Form
	Add player    Remove player    Player 1 Player's Name: Mother's Name: Medicare: Mother's Phone: Birth Date(mm/dd/yyyy): Father's Name: Gender: Male Female Father's Phone: Address: Emergency Contact Name: Emergency Contact Phone: Email Address: 2010 Helmet Requirement HELMET FEE - $15.00 - Each player is required to have their own MDMBA Approved helmet Required: Yes No 2010 Player Divisions (Please select Division that corresponds with the year of birth of player). (Note: Rally Cap must be 6 years of age by June 01, 2010) Rally Cap (2003 / 2004) Rookie (2001 / 2002) Mosquito (1999 / 2000) Pee Wee (1997 / 1998) Bantam (1995 / 1996) Midget (1992 / 1993 / 1994) Junior (1989 / 1990 / 1991)   Provincial Tryouts Division:   Select one Junior Midget Bantam Pee-Wee Mosquito Tryouts will start in May, subject to city signifying fields as playable. Phone 855-3633 for updates after May 1, 2010. 2010 Registration Fees One Player Family ($100)    Two Player Family ($175)    Three Plus Family ($200) Registration fee includes a $10.00 City of Moncton field levy and a $25.00 Baseball NB Fundraiser. Registrations are non-refundable after July 01, 2010. 2010 Volunteer Coach Assistant Coach Scorekeeper Equipment Mgr. Travel Mgr Canteen Umpire Special Events Other: Waiver I hereby waive and release the Moncton & District Minor Baseball Association Inc., its agents, representatives, coaches, officials, directors, and sponsors from any claim or actions from any injury which might be received by my child during any Association activities. I certify the above mentioned date of birth is correct and am willing to provide proof if necessary. I realize players are not insured and are not permitted at tryout or on the field until registration is complete, i.e. registration form completed in full, signed by parent/guardian, Medicare care number filled in, proof of date of birth supplied, if required and registration fee is paid in full. I am also aware that the association and the player’s coach should be made aware of any relevant medical condition as soon as possible. I agree with the above waiver. I DON'T agree with the above waiver. Date: