Salem Ballpark.....Where the game is still fun!!! - (Benton, AR)

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PLAYER INFORMATION

* Players First Name:

* Players Last Name:

* Street:

* City:

* Zip Code:

* Phone #:

* Players Gender:

* Players Date of Birth:

* Players age on 01/01/2025:

Check here if this is first time to play at Salem Ballpark

2024 Team/Coach (If player didn't not play at Salem in 2024 leave blank):

Do you want to stay with this team?:

Parent/Guardian #1

* Name:

* Relationship to Player:

* Phone #:

* Email:

* May we contact you at this email for promotional purposes?:

I am interested in coaching a team

PARENT/GUARDIAN #2

Name:

Phone #:

May we contact them at this email for promotional purposes?:

Email:

Is this person also a primary contact for player?:

Relationship to player:

They are interested in coaching a team

EMERGENCY CONTACT INFORMATION

PLEASE LIST SOMEONE OTHER THAN PARENT(S)/GUARDIAN(S) LISTED ABOVE

* Name:

* Phone #:

* Relationship to player:

By the execution of this agreement, it is hereby understood and agreed that the Salem Park Board and the Salem Athletic Board shall be held blameless for any injury sustained by my child while participating in the 2025 baseball and softball programs. I hereby release and forever discharge said Salem Park Board and Salem Athletic Board from any and all actions, causes of action, claims and demands for bodily injury and medical expenses arising out of my child's participation in the program.

I/we agree with the above *

* Enter your email address for confirmation reply:

PLEASE NOTE: THE REGISTRATION FEE FOR ONE PLAYER IS $60. IF YOU REGISTER TWO PLAYERS, THE TOTAL AMOUNT TO BE PAID IS $70. THE TOTAL FOR 3 OR MORE PLAYERS IS $90. IF YOU PAY LESS THAN THE ACTUAL AMOUNT DUE WHEN REGISTERING ONLINE, YOU WILL STILL OWE THE REMAINING UNPAID AMOUNT.

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