MERCEDES BASEBALL ACADEMY APPLICATION *

MERCEDES BASEBALL APPLICATION
FOR OFFICE USE ONLY
Admission Date

MonthDayYear
Date
Director's Initial
MERCEDES BASEBALL ACADEMY APPLICATION
Child's Name
Age
Home Phone #
Family Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip
School
School Address
School Phone
Parent/Guardian Information Parent/Guardian Information
Name
Relationship
Home Address
Phone
Reachable during program hours
Employer
Occupation
Employer City
Work Phone #
Work Hours
Parent/Guardian Information Parent/Guardian Information
Name
Relationship
Home Address
Phone
Reachable during program hours
Employer
Occupation
Employer City
Work Phone #
Work Hours
Emergency Contacts (EC) and alternative pick up Person (APP): You are required to list at least 2 people with whom you feel comfortable leaving your child and who can assume responsibility for your child if you could not be reached immediately in an emergency, or if for some reason you could not pick up your child and were unable to communicate with the program. Any changes to this list must be done in writing. No Exceptions! Please understand that we will ask for identification form anyone unfamiliar to us. * If a child is protected by a restraining order please submit a copy to the Child Care.
#1 Contact name
Relationship
Address
Phone
#2 Contact name
Relationship
Address
Phone
I authorize staff in Mercedes Baseball Academy who are trained in the basics of first aid/CPR to give my child first aid/CPR when appropriate

I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize the academy to transport my child to the nearest medical care facility and/or to nearest available medical facility secure necessary medical treatment for my child.
Work Phone #
Should be Empty:

MERCEDES BASEBALL APPLICATION

FOR OFFICE USE ONLY

MERCEDES BASEBALL ACADEMY APPLICATION