3D"Waynedale

Ages 3, 4, & = 5 &nbs= p; =20 Tuesday evenings &nbs= p; =20 6pm - 7pm

May 1 - May=20 29

Waynedale Baptist Church

633 Lower = Huntington=20 Road

Registration Sign-up at = Church = Family Life=20 Center on = Saturday, April=20 14 10am-12noon

or earlier at Church Office = Monday-Thursday=20 10am-4pm. Call 747-5400 for details.

-------------- = Cut and=20 return registration below to Church office on or before April 14th=20 ------------------

Player's = Name:___________________________ Age:______ Gender: M/F Birth=20 Date:____/____/____

Address:_________________________________________ =20 Zip:________ =20 Phone:____________

Shirt Size: YS (6-8) =20 YM (10-12) =20 YL (14-16)

Parent/Guardian = Name:=20 ___________________________________________________________________=

Alternate Phone = Number:=20 ___________________

Player = Emergency=20 Information

Allergies:_________________________________ &nbs= p; =20 Medical Problems:_____________________

Medications:______________________________

Insurance = Name:___________________________ &nbs= p; =20 Policy Number:________________________

Primary Insured = Name:______________________

I (we) hereby = grant=20 permission to seek medical treatment in the event I cannot be contacted. = ________(Initial)

I (we) do hereby = release,=20 absolve, indemnify, and otherwise hold blameless Waynedale Baptist = Church, the=20 organizers, sponsors, directors, and the officials appointed by them, of = any=20 damages, demands or actions whatsoever, which may arise or grow out of = his/her=20 participation in the Waynedale Baptist Church T-Ball=20 League.

Parent/Guardian = Signature:=20 _________________________________________ = Date:=20 _____/_____/_____

Players must be = of age by=20 May 1, 2012.

Registrations = will not be=20 accepted after Saturday, April 21.

Please call = Church office=20 for questions at 747-5400.

Please make = checks payable=20 to Waynedale=20 Baptist Church