CITY OF POTEAU RECREATION DEPARTMENT

Poteau Summer Youth Baseball/Softball Program

2012 Registration Form

AGE GROUP—PLEASE CHECK ONE

T-ball age cutoff: (Must be Five by May 1st)

_____T-ball (girls and boys ages 5 & 6)

Boys Baseball age cutoff: January 1 Girls Softball age cutoff: January 1

_____Coach Pitch (Ages 7 & 8) _____Coach Pitch (Ages 7 & 8)

_____Baseball (Ages 9 & 10) _____Softball (Ages 9 & 10)

_____Baseball (Ages 11 & 13) _____Softball (Ages 11-14)

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 $25.00 TO COVER COSTS OF ACCIDENT INSURANCE AND LEAGUE FEES.

Parent’s signature_________________________________________Date______/______/__________

Early Registration fee: $25.00 (make checks payable to “Poteau Summer Youth Program”)

Early Registration deadline: Friday, March 16, 2012
Late Registration fee: $40.00 deadline: Friday, March 23, 2012
Return this form, $25.00 registration fee, and a copy of the child’s birth certificate (by mail or in person) to:

Poteau City Hall

Summer Youth Program

111 Peters
Poteau, OK 74953