Breakers Baseball Club Registration Form

Youth Baseball Training Clinics 2021 - Registration Form (age 13 - 17)

Every Friday Evening - September 17, 2021 to March 25, 2022

George Jay Elementary School Gym - 1118 Princess Avenue, Victoria

6:00 pm - 8:30 pm

Every Sunday Afternoon - September 19, 2021 to March 27, 2022

Vic West Ball Park - 250 Esquimalt Road, Victoria

2:00 pm - 4:00pm

Cost

$200 - fees include a dri-fit shirt and hat
Athlete Information
Player Name *

First Name Last Name
Guardian / Parents Names *

First Name Last Name
Address *

Street Address

Street Address Line 2

City

Postal Code
Home Phone *

Area Code Phone Number
Cell Phone

Area Code Phone Number
E-mail *

Baseball skill level *

	1	2	3	4	5

1 is Begginer, 5 is Advanced

Date of birth

Month Day Year
Date
Dri-fit shirt size *
Name and number to go on shirt *
Hat size *
Important Notes · Covid-19 Protocols in place as directed by BC health professionals and WorkSafe BC. · Social distancing and frequent hand/equipment sanitizing will be enforced. · Dress appropriately. · Bring your own water. · Keep the gym/field clean.
Emergency Contact
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Does your child have any allergies, chronic illness, or medical conditions that would limit high level activtiy? *

Yes No
Please describe *
Has your child been vaccinated for Covid-19 *

Yes No
Release of Liability Although the safety of all sport activities is the primary concern, indoor/outdoor sport activities at the training facilities, batting cages and parks may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Breakers Baseball Club and the persons in charge.
I have read and agree to the above conditions *

Yes No
Confirmation E-mail *
Signature *

Clear
Baseball Skills Training Clinic - $200.00

7 months of baseball skills development. Registration fee includes a dri-fit shirt and hat.

Payment can be made by e-transfer to:

breakersbaseballclub@gmail.com

You can also pay by cheque payable to: Sherry Caven

Please contact Sherry Caven, Registrar, at breakersbaseballclub@gmail.com for more details on where to send the payment.
After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at breakersbaseballclub@gmail.com
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