Baltimore Youth Baseball Association

Baltimore Youth Baseball Association st

Participants Name:

. Age(as of May 1 )

. DOB

.

Address:

. City:

. Grade:

.

Participant's Shirt Size:

Adult Large____ Adult Medium____ Adult Small____ Youth Large14-16____ Youth Medium10-12____ Youth Small6-8____

Instructional____ 3 & 4yrs $20.00

T-Ball____ 5 & 6yrs $30.00

Minors____ 9 & 10yrs $100.00

Majors____ 11 & 12yrs $100.00

Coach pitch ___ 7 & 8yrs $80.00 st

nd

rd

Jersey #: 1 ______ 2 _______ 3 _______

Cash:____ Check number:____ Received by:

. Date:

.

Parent/Guardian Information / Medical/Emergency Information (E-Mail is our Primary Source of Communication, Please Print Clearly) Mother/guardian's Name:

. Home Phone (___)

.

E-Mail:

. Cell Phone: (___)

.

Father/guardian's Name:

. Home Phone (___)

.

. Cell Phone: (___)

.

E-Mail:

HOLD HARMLESS AGREEMENT In Consideration therefore, the undersigned parent(s) and/or guardian(s) hereby agree to hold harmless the Liberty Union-Thurston School District, the Village of Baltimore, and the Baltimore Youth Baseball Association, its officers, board members, coaches, and agents against all claims which the undersigned parent(s) and/or guardian(s), their child(ren), their respective heirs, executors, administrators, or assignors may have against Liberty Union-Thurston School district, the village of Baltimore and the Baltimore Youth Baseball association as a result of injuries which their child(ren) may sustain at or while participating in, or going to or from, any activity sponsored by the Baltimore Youth Baseball Association. Parents/Guardian Signature

.

Volunteer/Concession Information *In addition to signup fees, a $50 deposit/per player written in the form of a check is due at sign-ups. The check will not be cashed and will be returned once a parent or guardian works their shift at the concession. If a parent /guardian does not work their shift, they will forfeit the $50 to the association. Cash:____ Check number:____ Received by:

. Date:

.

___I am interested in Head Coaching Position

____ Please enter my child back into the Draft

___I am interested in an Assistance Coach Position

____ I am interested in Sponsorship

Baltimore Youth Baseball Association