CITY OF POTEAU RECREATION DEPARTMENT

Kiamichi Baseball League

2019 Registration Form

 

AGE GROUP—PLEASE CHECK ONE


Age Cutoff:  January 1

 

________ Coach Pitch (8U)

 

________ Pee-Wee (10U)

 

________ Midget (12U)

 

                                                                                                 

 

Player name________________________________________   Date of Birth ______/______/_______

 

Address_________________________________________  City____________________  State_____

 

Home phone (          )__________-_____________  Cell phone (          )__________-_____________

 

Age___________________  Grade_____________________    Sex        M           F

 

 Team manager last year____________________________________

 

I DESIRE AND CONSENT TO MY CHILD PARTICIPATING IN THE POTEAU SUMMER YOUTH PROGRAM AND ENCLOSED IS $50.00 TO COVER COSTS OF ACCIDENT INSURANCE AND LEAGUE FEES.

 

Parent’s Signature_________________________________________Date______/______/__________

$50.00 registration fee, and a copy of the child's birth certificate is needed at time of registraton