Fall Ball Application

Fall Baseball Program Application

Weekends September 6th—October 11th

 

13U                          15U                          18U

First Year Big Diamond                     Babe Ruth/Sr Little Leaguers         Varsity/Upper Classmen

 

Member Cost:    $180             Non-Member Cost:    $225 

 

Application for Enrollment

 

Name:			Date of Birth:
Address:
City:			State:	Zip:
Home Phone:			Work Phone:
Email Address:
Health Insurance Name			Insurance Number:

Payment Type:    Check (made out to THE HIT ZONE)         Credit (NO AMEX)              Amount:                                

Card Number:                                                                                                           Expiration Date:                                  

Card Holder Signature:                                                                                         Date:                                                         

 

I UNDERSTAND AND ACCEPT THE CONDITION THAT NEITHER MIKE GIARDI NOR ANYONE ASSOCIATED WITH THE HIT ZONE WILL ASSUME ANY RESPONSIBILITY FOR ACCIDENTS AND MEDICAL EXPENSES INCURRED AS A RESULT OF PARTICIPATION IN THE PROGRAM. THE APPLICANT IS IN GOOD HEALTH AND ABLE TO PARTICIPATE IN THE PHYSICAL ACTIVITY OF A VIGOROUS PROGRAM. I HEREBY AUTHORIZE THE DIRECTORS OF THE HIT ZONE TO ACT FOR ME ACCORDING TO THEIR BEST JUDGEMENT IN ANY EMERGENCY REQUIRING MEDICAL ATTENTION.

 

APPLICANT SIGNATURE:                                                                             DATE:                         

 

PARENT/GUARDIAN SIGNATURE:                                                            DATE:                         

                                                                                                                       (Required if applicant is under the age of 18)

 

Please mail this application to:

The Hit Zone P.O. Box 337 Swampscott, MA 01907

Please return this application in person to:

The Hit Zone 171 Essex Street Swampscott, MA 01907

(please print this page and return to the Hit Zone)