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"PLAYBALL" BASEBALL ACADEMY

2006 FLORIDA APPLICATION

PLEASE PRINT & FAX TO: (954) 772-4510

I have enclosed a deposit of $100.00 for a ______ week session starting from Sunday to Saturday. The balance of $_________ to be paid upon arrival. If 1 week selected, balance $550. If 2 weeks selected, balance is $1140. If 3 weeks selected $1,660. If 4 weeks selected $2,110. Balance of every student must be paid upon arrival.

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NAME_______________________ AGE _____DATE OF BIRTH _____________HT________ WT________

ADDRESS______________________________________________CITY__________________________

STATE____________ ZIP______________ HOME PHONE________________________ BAT L or R_____

THROW L or R______ POSITION__________________ HOME PAPER____________________________

IF UNDER 18, PARENT OR GUARDIAN SIGN HERE__________________________ DATE____________

INSURANCE COMPANY AND POLICY #_____________________________  SIGNED________________

SELECT YOUR SESSIONS IN 2006                       

JAN FEB MARCH APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC
1-7 5-11 5-11 2-8 7-13 4-10 2-8 6-12 3-9 1-7 5-11 3-9
8-14 12-18 12-18 9-15 14-20 11-17 9-15 13-19 10-16 8-14 12-18 10-16
15-21 19-25 19-25 16-22 21-27 18-24 14-22 20-26 17-23 15-21 19-25 17-23
22-28 26-4 26-1 23-29 28-3 25-1 23-29 27-2 24-30 22-28 26-2 24-30
29-4 . . 30-6 . . 30-5 . . 29-4 . 31-6

(Circle weeks you wish to attend)

METHOD OF PAYMENT

Cash, Money Orders, Certified Checks, Travelers Checks or Credit Card, NO PERSONAL CHECKS ACCEPTED. Tuition Fees...1 week $650; 2 weeks $1,240; 3 weeks $1,760; 4 weeks $2,210.

        _______________________ Exp Date_________ Sign_________________________

        ________________________Exp Date_________ Sign_________________________

Disc #         ________________________Exp Date_________ Sign_________________________

No postponement, cancellation or refund of deposit unless PBA is notified at least 6 weeks before date of session selected, in the event, deposit is never lost, but will be applied in a future session or can be transferred to another student with permission of PBA management, within a 2-year period. This also applies for students who must leave prior to their session ending. Permission is hereby given to PBA to use photographs and or endorsements of the students. "Playball" Baseball Academy and its staff is not responsible for lost or stolen personal possessions. All campers must provide his or her own personal injury insurance coverage.

SEND TO: "PLAYBALL" BASEBALL ACADEMY                                       TELEPHONE: (954) 776-6217

P.O. BOX 4898 FT. LAUDERDALE, FL 33338                                          FAX: (954) 772-4510