Dad’s Club Use Only

Senior League

Junior League

Major League

BERKLEY DADS’ CLUB

FALL 2009 REGISTRATION FORM

IMPORTANT: First time players are required to provide a copy of their birthcertificate. Please make sure to also include the player evaluation sheetobtained by visiting our website at You may alsocontactthe Fall League Director Jim Murley at: .

Major Division: AGES 8 – 10Junior Division: AGES 11 & 12Senior Division: Ages 13 – 15

NO ONE UNDER THE AGE OF 8 OR OVER THE AGE OF 15 IS ELIGIBLE TO PLAY, NO EXCEPTIONS

Last Name: ______First Name: ______Birth Date: Age: (OnDec1, 2009)

2009Berkley League: ______Team Name: ______

2009League (if not in Berkley): ______Team Name: ______

Did you play in the Berkley Dads’ Club Fall League Last Year? Yes No

List other Fall Sports Participating in: ______

PLAYER LIVES WITH (Circle One) Father / Mother / Both / Guardian

FATHER INFORMATION / MOTHER INFORMATION
Name / Name
Street Address / Street Address
City / City
State Zip / State Zip
Home Phone / Home Phone
Work/Cell phone / Work/Cell phone
Email Address / Email Address
Volunteer Here / Mother / Father
Manager
Assistant Coach
Umpire

Make checks payable to“BERKLEY DADS’ CLUB” and either mail to:

Berkley Dads’ Club, 1250 Cambridge, Berkley, MI48072 OR

Bring to Registration Days at the BerkleyCommunity Center:July 8 @ 6-9PM, July 11 @ 10-1PM, July 15@ 6-9pm

NO CASH PLEASE

Contract Fee (BerkleySchool District): / $45.00
Contract Fee (Non-BerkleySchool District: / $55.00
Late Fee (After July 24th): / $10.00
Total:
Check / Money Order No.:

DEADLINE FOR REGISTRATION IS JULY 30th

(Space is limited, first come first serve basis. Players signing up after July 24th will be charged a $10.00 late fee. Once leagues are full players may be put on a waiting list and are not guaranteed a spot on a team.)

I, the parent or legal guardian of the player named above give my approval to participate in the Berkley Dad's Club Fall Baseball program for the 2009 season. I do hereby release, absolve, and hold harmless this league, it’s officers, managers and coaches and waive all claims against said league supporters. I release responsibility for any persons transporting him to and from these activities. I further understand that falsifying this document may lead to disqualification from participating in any Dads’ Club sanctioned events.

Parent / Legal Guardian Name: ______

(Print)

Signature: ______Date: ____/____/____Check #:______

FOR LEAGUE USE ONLY [Birth Certificate verified by: ______]