Tee Ball
Baseball / Girls’ Softball
Registration April 1st - May 9th
Members $85 / Program Participants $125
Co-Ed Tee Ball: 3-4 Years Old
Co-Ed Baseball: 5-6 Years Old
Boys Coach Pitch: 7-8 Years Old
Girls’ Softball: 7-9 Years Old
Co-Ed Kid Pitch Baseball: 9-11 Years Old
Child’s Name_____________________________________________________________________
Mailing Address ___________________________________________________________________
City, State, Zip___________________________________________________________________
Home Phone ____________________________________________________________________
E-mail address (required) __________________________________________________________
Mom’s Name ________________________________
Cell Phone __________________________
Dad’s Name _________________________________
Cell Phone __________________________
Birth Date ____________ Age (as of August 1, 2014) _____
School
Gender
Male
Female
_________________________________________________________________________
Grade of child for upcoming Fall 2015 year ___________ (must include)
Jersey Size:
Pant Size:
YXS
AS
YXS
AS
YS
AM
YS
AM
YM
AL
YM
AL
YL
AXL
YL
AXL
Payment (check one):
Check enclosed (check box)
Charge:
Visa
Mastercard
Refund Policy Full refund if cancelled on or before May 18th, partial refund
(-$25 uniform fee) May 25th – May 31st, and no refund after June 1st.
PELHAM YMCA
2610 PLEHAM PARKWAY | PELHAM, AL 35124
P 664-9622 www.ymcabham.org/pelham
Coaching & Volunteering
Players without a coach will be notified and offered to move onto an open roster only. Full refunds will be
granted if a spot cannot be found on another team. Teams fill up before the deadlines, please register early.
To Parents/Guardian The strength of the Birmingham YMCA Super Sports program depends on volunteer
and parent participation. All teams are mandated to have a volunteer coach.
Let me know how I can help as a:
Coach
Assistant Coach
Team Sponsor
Name (please print): ________________________________________________________
Daytime #: ________________________ Email _________________________________
For more information contact Erin Smith at 664-9622 or [email protected]
This registration form is complete and accurate, and participant has permission to engage in all activities
unless otherwise specified in writing. I understand the Birmingham YMCA assumes no responsibility for
injuries or illnesses which my child may sustain as a result of his/her participation in athletics, the use of
any equipment, exercises or other activities. I expressly acknowledge that I assume the risk for any and all
injuries and all illnesses which may result from his/her participation in these activities. I acknowledge that
my child has been medically cleared to participate in vigorous physical activities. I also understand that
there is a risk of injury while participating in physical activity by my child. I agree to hold harmless the
YMCA, its staff and volunteers for accidents or injuries arising out of his/her participation in the activity.
Signature of Parent or Guardian _____________________________________________________
Note I hereby give permission to the personnel of the YMCA of Greater Birmingham, to video tape,
photograph, make a voice recording or motion picture of me and /or my minor child /children, to be used
in connection with the internet, printed materials, visual or auditory presentations, or to use in a depiction
of a swim team activity. Also, these items will be exclusive property of the Birmingham YMCA and I will not
receive any compensation for my participation.
PELHAM YMCA
2610 PLEHAM PARKWAY | PELHAM, AL 35124
P 664-9622 www.ymcabham.org/pelham