2010 Cotuit Kettleers Youth Baseball Clinic - Enrollment Form
For boys and girls ages 6-12, Monday thru Friday, 9:00 a.m. to 11:45 a.m.
(please print the form, complete ALL sections, and mail with payment to:
Cotuit Athletic Association, Box 443 Cotuit, MA 02635)

PLEASE PRINT CLEARLY

Child's First Name:________________________ Last Name:_______________________________

Child's DOB:___________________ (must be age 6 by 6/1/10 and no older than 12 as of 9/1/10

Parent's/Guardian's First Name: __________________Last:_______________________________

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

City__________________________State________Zip___________Tel:_________________________

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

City/Town/Zip ____________________ Telephone (during clinic hours):_______________________

Has your child attended before?_______If not, how did you hear about the program?

__________________________________________________________________________________________________

E-Mail Address: _______________________________________ Cell Phone: __________________

Youth Clinic fee enclosed: $90.00 Check #: ______________________________________

Credit Card Payments: Card Number ____________________________________ Exp:___________

Please enclose a non-refundable check for $90.00 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 are non-refundable.

Parent/Guardian Signature:

____________________________________________________________ __Date:________________

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