2018 Mount Ephraim Youth Athletic Association

2018 Mount Ephraim Youth Athletic Association - Registration Player's Name: ______________________________ _____________ Date of Birth: ________________________ _ Address: City: ______________________________________ I am registering for: Shirt Size:

Baseball

State: _________ Spring

Softball

Youth S M L XL Adult S M L XL

Hat :

Fall

XS/S

Mother's Name:

Occupation:

Mother's E-mail:

Mother's Mobile Phone #:

Father's Name:

Occupation:

Father's E-mail:

Father's Mobile Phone #:

Emergency Contact: ____________________________

Zip: Year: ______

S/M

M/L

L/XL

_

_

Phone #:

Medical Conditions/Allergies: ______________________________________________________________________ Last Team Played For: ______________________ _

Season: ____________ _

Division: ____________ _

I am interested in helping the league in the following areas: Team Manager Assistant Coach Field Committee Ladies Auxiliary Team Mom

Snack Stand

Volunteer Signature: __________________________________________________ (NOTE: All volunteers must also submit a background check application.)

(*League Use Only - Please Do Not Write Below This Line * ) Amount Paid: T-Ball $50 / Coach Pitch $120 / Minors $130 / Majors $150 / Jr-Sr $175 Cash/Check # _________ Phillies Raffle Ticket Numbers: Work Bond Birth Certificate Discounts:

Code of Conduct

Amount Owed:_______________ Medical Release

How many? ___________Child(ren) name(s) and Division(s): _______________________

League Age: __________

Division: ________________

Team: ____________________________

League Official: _______________________________ Date: __________________ League Comments: CODE OF CONDUCT ON OTHER SIDE OF FORM