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 #_________________
State: _______ Zip__________
Payment amount: _________ Enclosed
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.