2018 Advanced Player Development Registration Form
FOR MORE INFO ON MEMBERSHIP CLICK HERE
http://chicagomudcatsssc.com/training/clinics/advanced-player-development-memberships

Please complete the form below. After completing, a CONFIRMATION PAGE will pop up (you may need to scroll up) with detailed instructions regarding payment. Please following these instructions carefully.

If you have any questions, please do not hesitate to contact us at mudcatsstringer@gmail.com

All parents are required to sign a medical and media waiver prior to sending their child(ren) to Advanced Player Development programming. Currently, the waiver can be found on our website at http://chicagomudcatsssc.com/training/clinics/advanced-player-development-memberships (scroll down for the button linking you to the summer clinics waiver - please use this waiver). Please print and sign this waiver either email it to mudcatsstringer@gmail.com or have your player bring it with the first day they attend programming. Players will not be allowed to participate without a completed waiver on file.

PLAYER INFORMATION
You must complete a separate form for each player you are registering
Player First Name *
Your answer
Player Last Name *
Your answer
Player Date of Birth *
Your answer
Player School Attending/Grade (2017-2018 School Year) *
Your answer
Player Grade Level for 2017-18 School Year *
Your answer
Does your child play boys baseball or girls fast pitch softball? *
Will your child be playing on a Chicago Mudcat Team during the 2018 season? *
Which Mudcat team will your player be on during 2018? *
If your player is not a Mudcat, please indicate where they plan to play during 2018 under "other".
Player Email Address *
Enter N/A if not applicable
Your answer
Player Cell Phone Number *
Enter N/A if not applicable
Your answer
Player Home Phone Number *
Enter N/A if not applicable
Your answer
Please List Medical Conditions for Player (if any) *
Enter N/A for none
Your answer
Please List Allergies for the Player (if any) *
Enter N/A for none
Your answer
Will the Player Need Medication During Program Hours? If so please list below. *
Enter N/A for none
Your answer
Will the Player Bring an Epi-Pen or Inhaler to the program? If so please list below. *
Enter N/A for none
Your answer
PARENT/GUARDIAN INFORMATION
PRIMARY CONTACT
Relationship to Player *
First Name *
Your answer
Last Name *
Your answer
Primary Email Address *
Your answer
Secondary Email Address
If Applicable
Your answer
Home Phone Number *
Enter N/A if not applicable
Your answer
Mobile Phone Number *
Enter N/A if not applicable
Your answer
Work Phone Number *
Enter N/A if not applicable
Your answer
Best Way to Reach You *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Occupation *
Your answer
Employer & Title *
Your answer
Player Resides With...
PARENT/GUARDIAN INFORMATION
SECONDARY CONTACT
Relationship to Player
First Name
Your answer
Last Name
Your answer
Primary Email Address
Your answer
Secondary Email Address
Your answer
Home Phone Number *
Enter N/A if not applicable
Your answer
Mobile Phone
Enter N/A if not applicable
Your answer
Work Phone
Enter N/A if not applicable
Your answer
Best Way to Reach You *
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Occupation
Your answer
Employer & Title
Your answer
EMERGENCY CONTACT INFORMATION
Please indicate below two emergency contacts IN ADDITION to those listed above
EMERGENCY CONTACT INFORMATION - #1
Emergency Contact #1 First Name *
Your answer
Emergency Contact #1 Last Name *
Your answer
Emergency Contact #1 Home Phone *
Your answer
Emergency Contact #1 Mobile Phone *
Your answer
Emergency Contact #1 Work Phone *
Your answer
Emergency Contact #1 Relationship to Player *
Your answer
EMERGENCY CONTACT INFORMATION - #2
Emergency Contact #2 First Name *
Your answer
Emergency Contact #2 Last Name *
Your answer
Emergency Contact #2 Home Phone *
Your answer
Emergency Contact #2 Mobile Phone *
Your answer
Emergency Contact #2 Work Phone *
Your answer
Emergency Contact #2 Relationship to Player *
Your answer
ADVANCED PLAYER DEVELOPMENT PROGRAM REGISTRATION
Please make your selections below
Please register your player for a 20-week program membership below *
ADDITIONAL INFORMATION
Were you referred by anyone? If so, please provide their name.
Your answer
Please list names and phone numbers of those authorized to pick up your player from programming.
Players will not be released to anyone that is not on the authorized list
Your answer
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