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3D"Team
Name         E-mail Address<= /td>      
Address                  
City           State   Zip  
Telephone    (       &nbs= p; )                
Date of Birth         Height   Weight  
School               Grade  
Insurance Coverage           Insurance No.  
Doctor             Doctor's Teleph= one  
Parent/Guardian       Parent/Guardian=      
Address         Address        
City     State/Zip   City     State/Zip  
Telephone Home: (        )     Telephone Home: (        )    
  Work: (        )       Work: (        )    
Occupation         Occupation        
      = ORGANIZED BASEBALL HISTORY    
Primary Position: Secondary Position: Bats:   R    L    S Throws:    R=     L
High School Coach: Team: Phone:
Baseball Accolades
                   
                   
                   
                   
I= /We, the parent(s)/guardian of the above named candidate, give my/our approval= to participate in the Connecticut Blue Jays Program. I/We assume all risks a= nd hazards incidental to such participation including transportation; and I/= We do hereby
w= aive, release, absolve, indemnify, and agree to hold harmless the Organizers, Coaches, Sponsors, and Adult Supervisors, for any claim arising out of an injury to my/our child, whether the result of negligence or for any other cause, except to the extent
an= d in the amount covered by accident or liability insurance.
   
                 
Parent/Guardian Signature Parent/Guardian Signature
                 
    Date         Date    
Please Complete Registration Form and mail wi= th a $125.00 Registration/tryout Fee to:
Team Connecticut Blue Jays= 169 Geduldig Ave Bridgeport CT 06606
www.tcbsouth.com
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