2012 Shedd Park Baseball Organization Registration Form

Last Name

First Name

Birth Date

(mm/dd/yy)

Official

Age (1)

LastYear’s

Team

ThisYear’s

League

Fee

Med Cond

Yes/No (2)

(1a) A softball player’s Official Age is deemed to be his/her actual age on January 1, 2012.

(1b) A baseball player’s Official Age is deemed to be his/her actual age on April 30, 2012.

(2) If your child has a medical condition or uses medication, please provide a description on the back of this form.

Street:	Phone (home):	Email:
City:	Phone (work):	Email:
State:	Phone (cell):	Health plan:
Zip:	Phone (cell):	Health plan ID:

Volunteers:			Team Manager			Field Maintenance			Concession Stand Management
			Team Coach			Fund Raising			Other

League	Ages	Fee	League	Ages	Fee	League	Ages	Fee
T-Ball	5	$35	Minor Baseball	9-10	$55	Minor Softball	7-8	$55
Instructional	6	$35	Junior Baseball	11-12	$55	Junior Softball	9-12	$55
Rookie Baseball	7-8	$55	Senior Baseball	13-15	$75	Senior Softball	13-16	$75

Note: A $10 late fee will be added to all spring season registrations received after February 25, 2012.

Note: The third/forth/fifth/sixth child in a family will each be given a $20 fee deduction (spring season only).

By my signature below, I acknowledge that I have read and agree to the following:

I grant the Registrant permission to participate in the SPBO youth programs. I agree to not hold SPBO or its Officers, Directors, Managers, Coaches or other personnel working for SPBO responsible in the event of accident or injury to the Registrant during any SPBO activity including traveling to or from SPBO activities. I give permission, if I cannot be reached by telephone, for the Registrant to be treated with X-rays, sutures or any other treatment deemed necessary by attending Medical Personnel. I agree to be responsible for the proper use and care of all equipment and uniforms issued to the Registrant by SPBO, and to promptly return them to SPBO at the end of the season. As a condition of the Registrant being accepted into SPBO, the Registrant and parents, guardians and any other supporters of the Registrant (collectively “the Supporters”) are responsible for behaving properly and supporting all SPBO participants, including players, managers, coaches, umpires etc. during all SPBO activities. The SPBO reserves the right to expel the Registrant from the SPBO for actions by the Registrant or his/her Supporters that SPBO deems inconsistent with its goals. The SPBO Board of Directors shall be the sole judge in the matter. The sole remedy to the Registrant or his/her Supporters would be the refund of their league registration fees.

	Parent/Guardian	Spouse/Guardian
Printed name:
Signature:
Date:

For more information call Mike Mercuri at 978-454-3305.

Mail form to: SPBO, PO Box 8074, Lowell MA 01853.