Summer Surge Development Clinic
Registration Form
Athlete's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian Full Name
First Name
Last Name
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email Address
*
example@example.com
Training Shirt Size
*
Please Select
Small
Medium
Large
X-Large
XX-Large
Current Club
*
Please Select
Bayside-Westhaven
Central City
Central Sports
Christchurch Astros
Hamilton Raiders
Howick-Pakuranga
Hutt Valley Hornets
Hutt City United
Levin Hustle
Nelson Heat
North Shore
Orewa Sharks
Tauranga City
Wairarapa Spitfires
Waitakere Bears
Wellington City
West City
Not Currently Registered
Positions interested in receiving training on (select all that apply)
*
Pitcher
Catcher
1st Base
2nd Base
3rd Base
Short Stop
Left Field
Center Field
Right Field
Playing Experience
*
None
Beginner
Intermediate
Advanced
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Conditions or Allergies
Questions or Comments
Submit
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