Town of Collierville                        2003 T-ball Registration Form
Parks, Recreation & Cultural Arts                           

Registration Fee:      $50.00               
                                                                                   
Participant must be at least 5 or no older than 6 years of age on or before Aug 1, 2003.

Did you play last season with Collierville T-Ball Program?         YES        NO       

*     Add $20.00 late fee if received after 3/1/2003
*     All registration forms must be received by 3/1/2003
*     Refund requests must be in writing before 3/1/2003.  A $5.00 processing fee applies to ALL refunds
       3/1 to 4/1.
*     NO REFUNDS AFTER 4/1/2002.  Any forms received or postmarked after 3/1/2003 will go onto a waiting
       list. Participants placed on waiting list will receive a phone call only if pulled from list.
                                                                         

Last Name____________________________________  First Name                                                        

Address                                                                                                                                                            

City                                                                                        State                                 Zip                           

Home Phone (            )                                                      Sex___________  Date of Birth      /      /       

Email Address                                                                                                                  (please print clearly)

Father�s Name __________________________________    Day Phone (            )                                     

Mother�s Name__________________________________    Day Phone (            )                                     

Shirt Size  _________           Pant Size ________      (Please give sizes in youth small, youth medium, etc.)

NOTE - These sizes are used to assist in ordering uniforms for entire league.  Uniforms will not be custom fit.  Each will be uniformes as comfortably as possible.

We need volunteer assistance of parents to operate a quality program.  Would this parent be willing to help in the program as a volunteer?  (If interested in being a Head Coach, ask for a Head Coach Application Form.  Fill out and turn in to be interviewed)

HEAD COACH        _________      ASSISTANT COACH        _________      OTHER          _________
 

I/We do further hereby release, absolve, indemnify and hold harmless the Town of Collierville, Collierville Parks, Recreation & Cultural Arts Department, the organizers, sponsors, supervisors, all employees thereof, and/or all of the above, incidental to the conduct of activities and transportation to and from such.  In case of injury, I likewise waive all claims against the organizers, sponsors, employees, or any instructors appointed by them.  I/We imply that all information given on this form is true and understand that suspension from Collierville Programs is possible if any information is false.

Signature of Parent/Guardian____________________________________   Date_______________

FOR STAFF USE ONLY, PLEASE DO NOT WRITE IN THIS BOX

FEE PAID $_______       (CASH/CHECK) DATE PAID ___/___/___    BIRTH CERTIFICATE VERIFICATION  _______

RECEIPT #  ________________                                  STAFF MEMBER TAKEN BY  ___________

For more information on any athletic activities, call 853-3225.