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Spring 2013 REGISTRATION FORM Powered By Docstoc
					SPRING 2013                                                              Waialae-Kahala Athletic Club (WKAC)
                                                                                        PO BOX 240067
BASEBALL REGISTRATION                                                                Honolulu, HI 96824-0067

 ______Shetland Division 5-6 yrs old               (May 1, 2006 - Apr 30, 2008)   $100                                                         *** League Use Only ***
 ______Pinto Division    7-8 yrs old               (May 1, 2004 - Apr 30, 2006) $130                                                                                            BC:_____
 ______Mustang Division 9-10 yrs old                (May 1, 2002 - Apr 30, 2004) $140                            File Code: _____________ Draft: Y N        Protect: Y N
 ______Bronco Division   11-12 yrs old             (May 1, 2000 - Apr 30, 2002) $150                             Draft ID ___________ Team Assignment: ____________________________

                                                                                                                 Check #__________________ Receipt #______________ Amt:__________

                                                                                   PLAYER INFORMATION
                                Last Name                                                     First Name                                                           Date of Birth

                                                Mailing Address                                                            City                      Zip Code                   Home Phone

                                                                                   FATHER'S INFORMATION
                 Name                              Work Phone                        Cell Phone                                                    Email Address

                                                                                   MOTHER'S INFORMATION
                 Name                              Work Phone                        Cell Phone                                                    Email Address

 Are you willing to volunteer? Coach Asst-Coach Team-Parent Registration Field Maintenance Web-Update Other ___________
                                                                                   PREVIOUS EXPERIENCE
         Did you play in the 2012 WKAC Spring season?                      Y   N                               Division ___________________ Team _________________________________________

         Did you play in another league during the 2012 spring season?     Y   N                               League ___________________________________

         Number of years of previous experience ___________

                                                                                        UNIFORM SIZE

   JERSEY SIZE                    Youth:      YS       YM      YL        YXL                 Adult:      AS      AM       AL      AXL             CAP: Youth_____ Adult____
   PANTS SIZE                    Youth:       YXS YS   YM   YL   YXL        Adult:   AS      AM   AL    AXL
                                                    OTHER ACTIVITIES (Football, Basketball, Soccer, Scouting, etc…)
         Will your child be participating in other activities just prior to or during the Winter baseball season?                 Y     N
         If yes, please list activities: _____________________________________________________________                                       Finish Date: __________________________

                                                                                   MEDICAL INFORMATION
   Insurance Carrier: _______________________________________________________________                      Policy No: _________________________________________________________

   Physician: ______________________________________________________________________                       Phone: ____________________________________________________________

   Does you child have any medical disability or condition, allergy, or respiratory illness?        Y     N
   Please explain: _________________________________________________________________________________________________________________________________________

                                                      ALTERNATE EMERGENCY CONTACT                        (Parents will be contacted first)

  Name: ________________________________________________________________ Relationship: _______________________________ Phone:______________________________

                                                                         WAIVER, CONSENT AND HOLD HARMLESS

 I, the undersigned parent or guardian of the above-named player, as an inducement to register the above-named minor do hereby,
    1    Authorize the Waialae-Kahala Athletic Club (WKAC) and its officers, coaches or agents to refer said minor player, if injured or ill, to any licensed physician, hospital,
         or dental clinic or office it deems necessary when I or my spouse cannot be reached, in which case they shall be deemed as my agents to consent to medical, surgical
         and/or dental examination and/or treatment.
    2    Waive, release, absolve, indemnify and agree to hold harmless WKAC and its officers, directors, league officials, coaches or agents from all liabilities arising from
         death, bodily injury and/or property damage, which may be sustained by participation in any activity conducted or sponsored by WKAC, including transporting of
         said minor player to and from activities conducted or sponsored by WKAC.
    3    Permit any photos taken to be published on the league's web site.
    4    Acknowledge that there will be a $25 fee for all returned checks.
    5    Acknowledge that there will be a $25 late fee for all registrations received after the published registration deadline.
  ________________________________________________________                         _______________________                        _________________________________________
  Signature                                                                            Date                                       Relationship

www.waikahala.com                                                                       www.waikahala.com                                                                            www.waikahala.com

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