Baseball New Zealand

2010 Youth Clinics Registration

	Athlete's Details:

First Name: (*)	Please enter the player's First Name
Surname (*)	Please enter the Player's Last Name
Club	Invalid Input
School	Invalid Input
Medical Conditions	Invalid Input
Date of Birth (*)	Please enter the date of Birth in the format of dd/mm/yy

Parent/Guardian Name (*)	Please enter the Parent or Guardian's Full Name
Address	Invalid Input
Suburb	Invalid Input
City	Invalid Input
Telephone (*)	You must enter a contact phone number - just numbers, no spaces
Mobile	Invalid Input
Email Address (*)	Please enter an email address by which you can be contacted
	Parent/CareGiver Consent I give my consent for any First Aid to be administered in the event of an injury to my child, and for the instructors to seek medical help if necessary.
(*)	YesNo You must let us know if you will/will not consent to First Aid

Emergency Contact: (*)	Please enter a person who we can contact in case of emergency	Who should we contact in case of an emergency
Phone Number (*)	Invalid Input

	Baseball Clinics
Week 1 (Auckland)	n/a	Mon 4th January - Friday 8th January
Week 2 (Auckland)	n/a	Mon 11th January - Friday 15h January
Week 3 (Auckland) (*)	NoYes Please tick either yes or no	Mon 18th January - Friday 22th January
Week 4 (Auckland) (*)	NoYes Please tick either yes or no	Mon 25th January - Friday 29th January

	In registering for the clinics, I affirm that the information provided above is correct and grant permission for the player listed above to attend the BNZ Summer Programme.