Date_____________________

 

 

                         Contact Information

 

 

 

 

 

 

 

 

     Father - First Name    *   Mother - First Name

 

*Player Name   _____________________________

                                              ____________________     ____________________

 

 

 

 

 

 

 

 

 

 

 

 

 

*Address         ______________________________

W-___________________ W- __________________

 

 

 

 

 

 

 

 

 

 

 

 

 

*City,State Zip  ______________________________

C-____________________ C-___________________

 

 

 

 

 

 

 

 

 

 

 

 

*Home Phone  ______________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is it okay to send information regarding products or services from Fielder's Choice using - mail / e-mail?    Y    N

 

Would you like appointment reminders sent to your e-mail when it is available?   Y   N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E-mail address_____________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Height/Weight    _______/_______                                  Age/Birthdate (M/Y)   _______/_______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prior / Current Lessons @ FC  

            Instructor

 

 

 

 

 

 

 

Pitching            Y   N             __________________________                FC Camps Attended   Y   N           

 

 

Hitting               Y   N             __________________________                FC Clinics Attended   Y   N

 

 

 

Fielding            Y   N             __________________________                FC Hitting League      Y   N

 

 

 

Catching           Y   N             __________________________

 

 

 

 

 

 

Other                Y   N             __________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**NOTE**All fields with asterisks are required fields.