East Hanover Baseball Association
	PO Box 453, East Hanover, New Jersey  07936
	2005 Registration Form
	Child's Name______________________________________					Birthday_____/_____/_____
	Address__________________________________________					Grade__________________
	Telephone (______)_______-___________					Email Address________________
	Father's Name____________________________________					Mother's Name_______________
	Insurance Provider _________________________________					Policy # _____________________
		Birth Dates
	Division*	From	To		Amount
	T-Ball	8/1/1998	9/30/1999	$    65.00
	Cap	8/1/1996	7/31/1998	$    65.00
	Minor	8/1/1993	7/31/1996	$    80.00
	Major	8/1/1992	7/31/1995	$    80.00		**	Additional Children
							_____________________
	** A $10.00 discount is received for each
	additional child:		(Entitled Discount):				_____________________
	Total paid with registration				$		_____________________
	Payable to: East Hanover Baseball Association
	Check  #_____________		Cash_______________
	Would you allow your minor league aged child to be considered and/or play in the major
	league if drafted, and on approval of the E.H. Baseball Association Board of Directors?							YES   NO
	*While your child is ELIGIBLE, based on age, to participate at a certain level/division, there will be
	a skills assessment for any children wishing to participate in either the Minor or Major divisions.
	For safety reasons, this skills assessment will SUPERSEDE  age to determine the division your child
	would participate in.
	Birth Certificate - please bring a copy to registration						Certificate  _______
	I,___________________________, parent/guardian of the above named applicant hereby give my
	permission for him/her to participate in the East Hanover Baseball Association program of baseball
	and will assume all responsibility, other than that covered by insurance.  Also, I will not hold ANY
	MEMBER of the East Hanover Baseball Association responsible or liable should any unforeseen
	injury be sustained by my child or ward while he/she is playing baseball this season.
			______________________________________				____________
			(Parent/Guardian Signature)				(Date)
			Youth		Adult
	Shirt size (circle one)		S    M    L    XL		S    M    L    XL
	Pants size (circle one)		S    M    L    XL		S    M    L    XL
				VOLUNTEERS
						Coach	Division
	Name: _______________________________				Head Coach:	______	___________
					Asst. Coach:	______	___________
					Other:	___________________