'Lil Blue Devils ~ TACKLE FOOTBALL REGISTRATION FORM
Springfield Township Youth Baseball/Softball 2017 Summer Registration
Springfield Township Youth Baseball and Softball League
Please fill out one form per participant
~ [email protected] ~~ www.STYBS.com~ Participant LAST Name_______________
First: ____________
M.I.:______
Address:______________________________________________ Age, as of 1/01/17 (Girls), 5/01/17 (Boys):_______ Jersey Size of Participant:
Nickname: ______________
City:_______________
State:_______
Date of Birth:_____ /____ /_____
Youth: S (6/8) M (10/12) L (14/16)
Gender: M F ZIP Code:__________
Primary Phone: (___ )____ -____
Adult Sizes: S M L XL 2XL 3XL 4XL
Jersey # Request (no guarantee on jersey #) 1st Choice:_________ 2nd Choice: _________ 3rd Choice:_________
4th Choice:_________
Does participant live in Springfield School district or attend one of the Springfield Schools district schools?: Yes No Did participant play in this league last year?: Yes No If Yes, Coach and Team Name: ______________________________________ What Position/s did the participant play in the past?: Catcher Pitcher Infield Outfield N/A (Never played) Does participant now or will later this year play for any other league or team (Includes Travel Teams)? Yes No If Yes, League or Team type:___________________________________________________________________________________________
Parent/Guardian 1:_________________ Home ( Cell (
) _____- ______ ) _____- ______ TEXT Yes No Email:_________________________________
Parent/Guardian 2:_________________ Home( Cell (
) _____- ______ ) _____- ______ TEXT Yes No
Email:_________________________________
I can help in the following way(s). Head Coach Assistant Coach Umpire Concessions Fund Raisers Other:__________________ 2017 Fees: (Family Discount = $10.00 off each player after the 2nd player.)
Must live in the same household. Discount does not apply to the First 2 players.
Girls/Boys 5/6 - $45.00 Girls: 7/8 9/10 - $70.00 Girls 11/12 13/14 15 to 18 - $75.00 Boys: 7/8 9/10 11/12 - $70.00 Boys: 13/14 15 to 18 - $75.00 Registration forms received after March 4th, 2017 Will be charged a $15.00 late fee. The player will only be placed on a team if an opening is available. Any returned checks will be charged a returned check fee of $25.00 Person to notify in case of emergency (other than parent/s above): _______________________________ Phone:_________________________ Doctor to notify in case of emergency:________________________________________________________ Phone:_________________________ List any Medical Concerns (allergies, medications, Other):______________________________________________________________________
Medication Authorization – Grant of Consent. I hereby certify that I the parent or legal guardian of the registrant, a minor, is in good health and has my permission to participate in the STYBS program. I do understand that insurance is not provided and STYBS, Springfield Township, Springfield Township Schools and any other personnel involved with this program are not responsible for any injuries or accidents that may occur before, during or after any activities. In the event my child is injured and I cannot be reached to make emergency medical arrangements or circumstances make it impracticable for me to be reached, I give my permissions to contact emergency medical personnel and for any emergency treatment necessary, either on the practice facility, game facility or emergency room, I, the below signed, as a parent or legal guardian of the above listed child, understand there are certain risks and hazards associated with any and all activities and agree to accept the responsibility for medical services if necessary for the above child. I do hereby waive, release, absolve, indemnify and agree to hold harmless STBYBS, Springfield Township, Springfield Township Schools, the organizers, coaches, supervisors, participants and persons involved in the activity or those transporting my child, whether the results of negligence for any other cause and release them from all liability. Further; I the parent or legal guardian of the registrant, a minor, and the registrant, agree to abide by the rules of the S.T.Y.B.S. Further; the participant and I have read and agree to abide by the code of conduct issued with this registration form.
Parent/Guardian Signature_________________________________________ Date________________________ Mail completed form with check (payable to S.T.Y.B.S) to: Springfield Township Youth Baseball and Softball (S.T.Y.B.S) 2017 Registration, P.O.Box 293 Holland, OH 43528 STYBS Use Only Cash Check No.____________
Amount Paid:___________
Date Rec’d:____________
Initials______________
Springfield Township Youth Baseball and Softball League
Please fill out one form per participant
~ [email protected] ~~ www.STYBS.com~ Participant LAST Name_______________
First: ____________
M.I.:______
Address:______________________________________________ Age, as of 1/01/17 (Girls), 5/01/17 (Boys):_______ Jersey Size of Participant:
Nickname: ______________
City:_______________
State:_______
Date of Birth:_____ /____ /_____
Youth: S (6/8) M (10/12) L (14/16)
Gender: M F ZIP Code:__________
Primary Phone: (___ )____ -____
Adult Sizes: S M L XL 2XL 3XL 4XL
Jersey # Request (no guarantee on jersey #) 1st Choice:_________ 2nd Choice: _________ 3rd Choice:_________
4th Choice:_________
Does participant live in Springfield School district or attend one of the Springfield Schools district schools?: Yes No Did participant play in this league last year?: Yes No If Yes, Coach and Team Name: ______________________________________ What Position/s did the participant play in the past?: Catcher Pitcher Infield Outfield N/A (Never played) Does participant now or will later this year play for any other league or team (Includes Travel Teams)? Yes No If Yes, League or Team type:___________________________________________________________________________________________
Parent/Guardian 1:_________________ Home ( Cell (
) _____- ______ ) _____- ______ TEXT Yes No Email:_________________________________
Parent/Guardian 2:_________________ Home( Cell (
) _____- ______ ) _____- ______ TEXT Yes No
Email:_________________________________
I can help in the following way(s). Head Coach Assistant Coach Umpire Concessions Fund Raisers Other:__________________ 2017 Fees: (Family Discount = $10.00 off each player after the 2nd player.)
Must live in the same household. Discount does not apply to the First 2 players.
Girls/Boys 5/6 - $45.00 Girls: 7/8 9/10 - $70.00 Girls 11/12 13/14 15 to 18 - $75.00 Boys: 7/8 9/10 11/12 - $70.00 Boys: 13/14 15 to 18 - $75.00 Registration forms received after March 4th, 2017 Will be charged a $15.00 late fee. The player will only be placed on a team if an opening is available. Any returned checks will be charged a returned check fee of $25.00 Person to notify in case of emergency (other than parent/s above): _______________________________ Phone:_________________________ Doctor to notify in case of emergency:________________________________________________________ Phone:_________________________ List any Medical Concerns (allergies, medications, Other):______________________________________________________________________
Medication Authorization – Grant of Consent. I hereby certify that I the parent or legal guardian of the registrant, a minor, is in good health and has my permission to participate in the STYBS program. I do understand that insurance is not provided and STYBS, Springfield Township, Springfield Township Schools and any other personnel involved with this program are not responsible for any injuries or accidents that may occur before, during or after any activities. In the event my child is injured and I cannot be reached to make emergency medical arrangements or circumstances make it impracticable for me to be reached, I give my permissions to contact emergency medical personnel and for any emergency treatment necessary, either on the practice facility, game facility or emergency room, I, the below signed, as a parent or legal guardian of the above listed child, understand there are certain risks and hazards associated with any and all activities and agree to accept the responsibility for medical services if necessary for the above child. I do hereby waive, release, absolve, indemnify and agree to hold harmless STBYBS, Springfield Township, Springfield Township Schools, the organizers, coaches, supervisors, participants and persons involved in the activity or those transporting my child, whether the results of negligence for any other cause and release them from all liability. Further; I the parent or legal guardian of the registrant, a minor, and the registrant, agree to abide by the rules of the S.T.Y.B.S. Further; the participant and I have read and agree to abide by the code of conduct issued with this registration form.
Parent/Guardian Signature_________________________________________ Date________________________ Mail completed form with check (payable to S.T.Y.B.S) to: Springfield Township Youth Baseball and Softball (S.T.Y.B.S) 2017 Registration, P.O.Box 293 Holland, OH 43528 STYBS Use Only Cash Check No.____________
Amount Paid:___________
Date Rec’d:____________
Initials______________
