Cotuit Kettleers Advanced Baseball Clinics 2010 - Enrollment Form

For boys and girls ages 11-13 and 14-16

Please print the form, complete ALL sections, and mail with payment of $150.00 made payable to the

Cotuit Athletic Association to: Kettleers Baseball Clinics, P.O. Box 443, Cotuit, MA 02635

 

PLEASE PRINT CLEARLY

 

Child's First Name:________________________Last Name:__________________________________

Child's DOB:_________ (must be age 11 by 6/1/10 and no older than 16 as of 7/1/10)

Parent's/Guardian's First Name: ____________________Last:__________________________________________

Parent's/Guardian's PERMANENT Mailing Address:__________________________________________________

City________________________________State___________Zip___________Telephone:______________________

Parent's/Guardian's LOCAL Summer Address: ______________________________________________________

City/Town____________________Emergency Telephone (during clinic hours):____________________________

Has your child attended before?_______ Years: _______________________________________________________

Credit Card Payments: Card Number _____________________________________________ Exp. Date _________

E-Mail Address: __________________________________________________________________________________

 

2010 Advanced Clinic Sessions located at Elizabeth Lowell Park, 10 Lowell Avenue, Cotuit, MA

Monday through Friday, 9:00 - Noon

June 28- July 2_______ July 12-July 16_______

 

Please enclose a non-refundable check for $150 per child for each session requested. APPLICATIONS WILL NOT BE ACCEPTED AT THE CLINIC SITES. Checks should be made payable to: COTUIT ATHLETIC ASSOCIATION. Please indicate a second choice in the event your first choice is not available. A waiting list will be maintained when sessions are full. Spaces will be allocated on a first come, first served basis as they become available. Payments will be returned to waiting list applicants who are not placed in a session. We make every effort to accommodate all interested children. Confirmations of enrollment, as well as clinic policies and procedures, will be sent to all applicants. It is understood that the Town of Barnstable, its School Department, its Recreation Department, the Cotuit Athletic Association, or their agents, assume no liability for accidental injury. All fees submitted are nonrefundable.

 

 

Parent/Guardian Signature:

 

______________________________________________________________Date:__________________

Medical carrier and policy #: _______________________________________________________________________

Questions regarding policies and procedures may be directed to Stacy Wardwell (508) 428-2847, clinics@kettleers.org