Clinics  Mental Training                                        

                          Batters Box Program Registration


        you may print a copy of this form using your pc browser print function.

Enrollment Program:  _____________________________

Players Name ________________________  Date of Birth________

Parent/Guardians Name____________________ Medical Conditions?______

Home Phone #:________________ Work Phone #_________________

Address:________________________________ City______________

State: _______  Zip__________

Payment amount: _________  Enclosed

Charge to

   Master Card  _________________________  exp date _________

   Visa ________________________________  exp date_________

Enclosed is my $50.00 deposit to reserve space in this program.  I understand the balance is due on or before the first day of class. I understand that my deposit is non refundable unless this program is canceled.  I also understand once my child begins, if he or she is unable to attend, no partial refund will be made available.  The missed sessions can be made up in another class if one is available during the same class period.  I release and hold harmless the Batters Box and their representatives from any and all liability as a result of attending this program.