2021 SPRING Lakewood Baseball/Tball Registration & Payment Form

1

Player's Name* This field is required.

First Name

Last Name

2

2021 LPOA FULL MEMBER OR ASSOCIATE FULL MEMBER* This field is required.Are you a current 2021 LPOA Member or Associate Member ( MUST have 2021 Dues Paid to receive discounted price). You or you child do not have to be a member to play on one of our teams.

YESNO

3

If Yes, Enter Player's LPOA 2021 Member Number (on top of 2021 ID card)Child LPOA Member Number

4

Address* This field is required.Current Home/Mailing Address

Street Address

City

State

Zip Code

Country

5

Male or Female * This field is required.Gender

6

Birthdate* This field is required.

Date

7

Player's Age on April 30, 2021* This field is required.

8

League you are registering for now- * This field is required.

9

Number of Years Child has Played? * This field is required.

10

Was your child registered to play Baseball or T-Ball in 2020 ( spring or fall)* This field is required.

YESNO

11

What park/club did your child play for in 2020?

12

My player's 2020 Lakewood Coaches Name Was?

13

Parent/Guardian Name #1* This field is required.

First Name

Last Name

14

Email Address Parent/Guardian #1 * This field is required.

example@example.com

15

Cell #1Phone Number* This field is required.

Area Code

Phone Number

16

Parent/Guardian Name #2

First Name

Last Name

17

Cell #2 Phone Number

Area Code

Phone Number

18

Would you like to Volunteer to Coach? * This field is required.Please select one of the following options

19

If YES, Thank You!! Please enter information below. .

NAME

Please enter coach interest email

Please enter coach interest cell phone

20

Would you or a business you know of like to sponsor a team for $400* This field is required.Your businesses logo will be displayed on your child's team jerseys

21

If yes, THANK YOU!! Please enter business contact information.

Business Name

Contact Name

Please enter Contact Email

Please enter Contact Phone number and extension if necessary

22

Player's Uniform Shirt/Jersey Size* This field is required.

23

Baseball Cap SizeYouth or Adult Sized

24

Player's Uniform Pant Size? * This field is required.

25

Any additional notes/requests you would like our staff to know? * This field is required.Type "N/A" if you want to leave blank. Depending on registration numbers, some requests may not be able to be accommodated.

26

Please upload a copy of your child's birth certificate for player age verification. If you prefer to deliver a copy in person, please bring it to our office and put it in our mail slot.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

27

*MANDATORY....SKILLS ASSESSMENT for 7 yr + players will be held on SATURDAY, February 27th, 2021 during the following time brackets according to players Last Name:

12:00-1:30pm A-L

1:30-3:30pm M-Z

**You MUST bring a COPY of your Child's Birth Certificate to Skills Assessment on 2/27/2021 unless you upload it to this registration.

***Assessment Date subject to change. You will be notified if it affects your registered player***

28

LPOA Activities Photo Waiver.* This field is required.Photo Permission/ Release: By registering my child in LPOA's Youth Sports Program, I hereby give Lakewood Property Owners Association permission to utilize sports or event photos that may include my child. Photos and videos that are taken by LPOA may be used for current or future marketing in both print and social media materials. Photos will be used to help promote Lakewood Property Owners Association’s programs and benefits to its members, future members, and sponsors. I hereby waive all claims for damage or loss incurred directly or indirectly in connection with any released photos. This Permission/Release shall be binding upon the submission of my child's registration form

I acknowledge and agree to this LPOA Photo Waiver

29

I have read The LPOA 2021 Liability Waiver and I agree. * This field is required. 1. I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. 2. I further acknowledge that the Lakewood Property Owners Association ("LPOA") has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19, following guidelines from both the Center for Disease Control ("CDC") and the Arkansas Department of Health ("ADH"). 3. I further acknowledge that the Lakewood Property Owners Association cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I hereby release and agree to hold the LPOA harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the LPOA, or that may otherwise arise in any way in connection with any facilities used of the LPOA and/or services received from the LPOA. I understand that this release discharges the LPOA from any liability or claim that I, my heirs, or any personal representatives may have against the LPOA with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from the LPOA or facilities of the LPOA that I have used. This liability waiver and release extends to the LPOA together with all owners, partners, and employees. This Permission/Release/Waiver shall be binding upon the submission of my child's registration form.

YESNO

30

Unique ID

31

Registration Fees for Spr 2021

My Bag

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5-6 yr T-ball (Coed) -LPOA Member (Must have paid 2021 LPOA dues)
$100.00+Remove
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7-8 yr Cal Ripken (CP) - Non-Members
$120.00+Remove
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7-8 yr Cal Ripkin (CP) - LPOA Member (Must have paid 2021 LPOA dues)
$95.00+Remove
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9-10 yr Cal Ripken- Non-Members
$125.00+Remove
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9-10 yr Cal Ripken- LPOA Member (Must have paid 2021 LPOA dues)
$100.00+Remove
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11-12 yr Cal Ripken- Non-Members
$135.00+Remove
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11-12 yr Cal Ripken- LPOA Member (Must have paid 2021 LPOA dues)
$110.00+Remove
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Registration Fees for Spr 2021

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