Email address *

PLAYER INFORMATION

Player First Name: *

Player Last Name: *

Street Address: *

Street Address:

City *

State: *

Zip Code: *

Date of Birth: *

Date Picker

Season Trying Out For: *

Home Phone:

Player Cell:

Player Email Address:

Player Twitter Handle:

Height(ft./in.): *

Weight(lbs.) *

School Attending: *

High School Graduation Year: *

Current Grade: *

Primary Position: *

- Select One -

Pitcher Catcher 1st Baseman 2nd Baseman 3rd Baseman Short Stop Right Field Center Field Left Field

Secondary Position: *

Bats *

Throws: *

School/Other Team coach:

School Team/Other Team:

School Coach/Other Team Coach Phone:

PARENT/GUARDIAN INFORMATION:

Parent/Guardian 1 Full Name *

Parent/Guardian 1 Street Address: *

Parent/Guardian 1 Street Address:

Parent/Guardian 1 City: *

Parent/Guardian 1 State: *

Parent/Guardian 1 Zip Code: *

Parent/Guardian 1 Cell Phone: *

Parent/Guardian 1 Email Address: *

Parent/Guardian 1 Twitter Handle:

Parent/Guardian 1 Occupation: *

PLAYER MEDICAL INFORMATION:

Insurance Coverage:

Insurance Number:

Doctor Name:

Doctor Phone Number:

TCB TEAM WAIVER:

I/We, the parent(s)/guardian(s) of the above named candidate, give my/our approval to participate in the Team Connecticut Baseball, Inc./Connecticut Baseball Academy, Inc. Program. I/We assume all risks and hazzards incidental to participation including transportation; and I/We do hereby waive, release, absolve, indemnify, and agree to hold harmless the organizers, coaches, sponsors, and adult supervisors for any claim arising to my/our child, whether the result of negligence or for any other cause, except to the extent and in the amount covered by accident or liability insurance.

TCB PAYMENT AND DEPOSIT INFORMATION:

TCB HAS GONE GREEN. We have taken steps to make TCB environmentally friendly, in doing so we have eliminated all paper invoices for Team deposit and tuition payments.

All credit card tuition payments will be processed on the 10th of each month beginning in December through May/June. By entering your credit card information below I authorize TCB to charge my credit card for the purpose of monthly tuition payments.

I understand if selected on a TCB Team my deposit will be subtracted from my total tuition balance.

I also understand if I am not selected for a TCB team I will be refunded my deposit and I will not be charged any monthly tuition payments.

NOTE: Any player that leaves a team for any reason after the acceptance process will not be refunded any of the monies that were previously paid.

Please use the below credit card information for: *

$595 Non-Refundable Deposit only $595 Non-Refundable Deposit & Monthly Tuition Payments Monthly Tuition Payments Only

Credit Card Type:

Name as Appears on Card:

Credit Card Number:

Expiration Date(mo/yr):

CVV Code:

I have read, and agree to all the above terms and conditions. *

YES

I have filled out all information above correctly and accurately. *

YES

* required field

Middletown TCB Try-out Registration

PLAYER INFORMATION

PARENT/GUARDIAN INFORMATION:

PLAYER MEDICAL INFORMATION:

TCB TEAM WAIVER:

TCB PAYMENT AND DEPOSIT INFORMATION: