Minor Baseball 2015 application - Dofasco

ArcelorMittal Dofasco Minor Baseball League
2015 Registration
Please Read Information on reverse side prior to completing the application.
Signatures are required to process application
Contact: Tom Hixson 905-574-1082 or Ted Todoschuk 905-578-5902
Player’s Name:___________________________________________________________________
Player's Address: ________________________________________________________________
#
Street
City
Postal Code
Contact Phone #
_______________ Parent E-mail address_____________________________
Other Email addresses to be used________________________________________________________
Parents Signature: ______________________________________________________________________
(Signature required for players less than 18 years by parent/guardian. If 18 or over, then players
signature required)
NOTE: We will not need a copy of the player’s birth certificate this year.
I understand that any personal information collected, used or disclosed is solely for the purpose of administering the
Recreation Programs for me and my dependants and that I, my son daughter/spouse or ward participates in these
activities at my/their own risk and there shall be no liability whatsoever attached to ArcelorMittal Dofasco, its servants,
agents, employees, other participants, or independent contractors for any loss, damage or injury of any nature, however
caused. In case of any medical or other emergency that may occur while son/daughter/spouse, my ward or I is
participating in these activities, I hereby authorize ArcelorMittal Dofasco, its servants and employees, to take such action
as they consider appropriate, including, without limitation, providing or obtaining medical or surgical attention.
Please indicate (circle) if you are registering as: Employee’s Child OR Grandchild OR Associate or Self
Employee's/Grandparent’s/Sponsor Name ____________________________ Perm. No. _________
Department _____________________________________________ Ext. ________
Address (if different than applicant’s) __________________________________________________
#
Street
City
Postal Code
Contact Phone #
_________________
E-mail address__________________________________
Employee/Grandparent or Sponsors Signature ___________________________________________
(Associate players please note: Sponsor’s signature is mandatory requirement)
Park Date Stamp here: RATES ON REVERSE SIDE
2015
1996 or earlier
Junior
Bantam
Midget
2000/01
Peewee
1997/98/99
2002/03
dd/mm/yyyy
Mosquito
Date of Birth
2004/05
Has Child
Registered
Before
Y/N
Rookie
M
or
F
T-Ball
Child's Name
(List each child in your
family in the spaces
provided
below)
2006/07/08
2009/2010
Year of birth
Child 1:
Child 2:
Child 3:
Registration Fees (HST included):
Junior
Midget
Bantam
Peewee
Mosquito
Rookie
T-Ball
Employee Child
Grandchild or Associate
$380.00
$210.00
$210.00
$190.00
$150.00
$140.00
$70.00
$400.00
$220.00
$220.00
$200.00
$160.00
$150.00
$80.00
Note: Cheques can be postdated to April 17, 2015
Note:There will be a $20.00 charge for NSF cheques.
Registration fee must be enclosed with your application form. If paying this fee by cheque, make the cheque
payable to DOFASCO MINOR BASEBALL LEAGUE and mail the application and cheque to: ArcelorMittal
Dofasco Inc., P.O. Box 2460, Hamilton, Ontario, L8N 3J5, Attention: Recreation Department.
NOTE: Our ability to have teams in each category will depend on the number of applications.
Please have them in by April 17, 2015 so we can plan accordingly. We will be taking
applications after this date, but it would help if you can get them in by this date
For Office use only:
Paid by: CASH / MONEY ORDER / CHEQUES
Date:
Date:
Amount
Amount
Cheque #
Cheque #
$