Register for Baseball Academy

After registering below you will be redirected to PayPal where you can pay the registration fee via credit card or PayPal account.

Please select your Payment Options *

Registration for the Livingston County Region Full Payment will be due by January 15, 2014. You may make that payment now, but to reserve your spot a down payment must be made by November 1, 2013

Full payment - $400

Down payment - $200

First Name: *

Last Name: *

Address

City

State

Zip

Home Phone:

Cell Phone

Player's E-mail Address: *

Father's Name

Fathers Email Address:

Mother's Name

Mothers Email Address

School

Grade

Date of Birth

Position #1 Baseball

Position #2 Baseball

Pants Size

Shirt Size

Insurance Carrier

Policy Number

Physician's Name

Medical Conditions

Emergency Contact

I/We give permission for any medical attention necessary to be administered to my/our child by a licensed Medical Professional in the event of an accident or injury until I/we can be contacted. This release is effective for the 2013 season. I /we will assume responsibility for payment of treatments.

I/We the parent of the above named child, give my approval for his/her participation in any and all activities of the RPA LLC. during the 2013 season.

I/We do further release, indemnify and hold harmless any liability, direct or indirect, from anyone representing the RPA LLC., and/or any of the members, officers, organizers, supervisors, any and all of them. In case of injury to my child, I hereby waive all claims against the organizers.

I am the parent/guardian above. I have read the waiver above and agree to all the terms & conditions.

Parent E-Signature

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Register for Baseball Academy