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Mosquito A Port Coquitlam

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Announcement

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FALL BALL 2013 REGISTRATION

Posted by TONY YEE on Jul 16 2013 at 05:00PM PDT

https://secure.mailjol.net/allforms/u/65238b55.php

ALL FIELDS ARE NEEDED TO BE FILLED BEFORE SUBMITTING
FALL BALL REGISTRATION
Questions marked by * are required.
1. Division: *
  • 2005 & 2006 ( Tadpole)
  • 2003-2004 (Mosquito)
  • 2001-2002 ( Pee Wee)
  •  
  • 1996,1997 & 1998 ( Midget )
  • 1995 ( Midget over age)
2. Are you new to VMBA ? *
3. Last League that you played in : *
4. Family Last Name *
5. Player's Name *
6. Address: *
7. City : *
8. Postal Code: *
9. Sumitter Email: *
10. Date of Birth ( YYYY-MM_DD) *
11. Home Phone Number *
12. Mother's / Guardian Cell Phone:
13. Dad's / Guardian Cell Phone:
14. Any Medical Concerns ? *
15. Mother's /Guardian Name *
16. Father's / Guardian Name *
17. Emergency Contact *
18. Emergency Phone Number *
19. Wavier of Liability *
  • I ACCEPT
  • AS THE PARENT/GUARDIAN OF THE ABOVED NAMED PLAYER, I DO HEREBY GIVE MY APPROVAL FOR MY CHILD TO PARTICIPATE IN ANY AND ALL BASEBALL ACTIVITIES FOR THE CURRENT SEASON. I ASSUME ALL RICKS AND HARZARDS INCIDENTAL TO HIS/HER PARTICIPATION AND I WILL AGREE TO WAIVE, RELEASE, ABSOLVE AND PROMISE TO INDEMNIFY AND SAVE HARMLESS THE VANCOUVER MINOR BASEBALL ASSOCIATION, ITS OFFICERS,MANAGERS,COACHES,UMPIRES,PARTCIPANTS AND PERSONS TRANSPORTING MY CHILD FROM ANY AND ALL LIBILITY, INCLUDING NEGLIGENCE. I have read the waiver of liability and agree. If you don not agree, you cannot submit this form: Please check : I ACCEPT
20. Registered By:( Must be a legal guardian) *
21. TERMS: *
  • I AGREE TO THE ABOVE TERMS,Please be advised that the submission of this registration form does not guarantee a spot in our Fall Ball program. Please bring full payment to your first Fall Ball Pracitce and a roster spot will be held for you. Space is limited.
 
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