Age Group   [   ] 6&under    [   ] 8&under    [   ] 10&under     [   ] 13&under     [   ] 14&over     [   ] unknown        Date: _________

Last Name:

First Name:

MI:

Street Address:

Town:

State:

Zip:

Phone:

Birth date: (MM/DD/YYYY)

 Age as of Jan 1st:

School:

 Grade:

Email:

 Last Team: Yrs Experience:

          Parent Information - Father

Last Name:

First Name:

Home Phone:

Work Phone:

Ext:

Occupation:

Email:

          Parent Information - Mother

Last Name:

First Name:

Home Phone:

Work Phone:

Ext:

Occupation:

Email:

          Emergency Contact Information  (Used if parents are not available)

Name:

Phone:

Relation:

Doctor:

Phone:

Notes:

 

Heath Ins. Co.

Policy #

          Registration Fees (*)              payment type:    [  ]check     [  ]credit card (on-line only)
Item Rates

Amount

Player Fee (8U, 10U, 13U, 14+) $125  $ 125
Player Fee (6&under) $85  
Two siblings $205  
Two siblings (both 6&under) $165  
Three or more siblings $250  
Late Fee (6U, 8U, 10U, 13U) $10, if registering after February 16  

Grand Total

 Make Checks Payable to "Midway Girls Softball"
Enter Your CHECK Number here _______________		 $
 Volunteer Activities (check interests)
 [   ]   Opening Day
[   ]   Banquet
[   ]   Coach (specify age group)  __________
[   ]   Complex Maintenance
[   ]   Field Day
[   ]   Other  __________________________

(*) This registration fee includes a $25 participation fee per household which is refundable upon completion of a board-approved volunteer activity.  To receive a refund the participant must (1) complete the activity, (2) complete the Volunteer Participation Refund form which must be signed by a board member, and (3) mail the form to the MGS address listed on the form by July 31.

Special Comments:  (PLAYERS NEED TO PROVIDE THEIR OWN PANTS AND GLOVE.  Requests for team assignments are not guaranteed; New players to an age division may go through a draft process.)
                  www.midwaygirlssoftball.org

   Mail registration and waiver forms along with check to:
                      MGS Registrations
                      Box 417
                      Hockessin, DE 19707                       Rev.01/08