'Lil Blue Devils ~ TACKLE FOOTBALL REGISTRATION FORM
Springfield To wnship Yo uth Baseball/So ftball 2016 Summer Registratio n
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.:______
Addre ss:______________________________________________ Age , as of 1/01/16 (Girls), 5/01/16 (Boys):_______ Je rse y Size of Participant:
Nickname: ______________
City:_______________
State:_______ ZIP Code:__________
Date of Birth:_____ /____ /_____
Youth: S (6/8) M (10/12) L (14/16)
Gender: M F
Primary Phone: (___ )____ -____
Adult Sizes: S M L XL 2XL 3XL 4XL
Je rse y # Request (no guarantee on jersey #) 1 st Choice:_________ 2 nd Choice: _________ 3 rd Choice:_________
4 th Choice:_________
Doe s 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) Doe s participant now or will later this year play for any other league or team (Includes Travel Teams)? Yes No If Ye s, League or Te am type :___________________________________________________________________________________________
Pare nt/Guardian 1:_________________ Home ( Cell (
) _____- ______ ) _____- ______ TEXT Yes No Email:_________________________________
Pare nt/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:__________________ 2016 Fees: (Family Discount = $10.00 off each player after the 2 nd player.) Must live in the same household. Discount does not apply to the First 2 players.
Girls/Boys 5/6 - $40.00 Girls: : 7/8 9/10 11/12 13/14 15 to 18 - $70.00 Boys: 7/8 9/10 11/12 13/14 - $70.00 Boys: 15 to 18 - $75.00
Re gistration forms received after March 5 th, 2016 Will be charged a $15.00 late fee. T he 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 Pe rson 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 p articipate 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 person nel 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 t he 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) 2016 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.:______
Addre ss:______________________________________________ Age , as of 1/01/16 (Girls), 5/01/16 (Boys):_______ Je rse y Size of Participant:
Nickname: ______________
City:_______________
State:_______ ZIP Code:__________
Date of Birth:_____ /____ /_____
Youth: S (6/8) M (10/12) L (14/16)
Gender: M F
Primary Phone: (___ )____ -____
Adult Sizes: S M L XL 2XL 3XL 4XL
Je rse y # Request (no guarantee on jersey #) 1 st Choice:_________ 2 nd Choice: _________ 3 rd Choice:_________
4 th Choice:_________
Doe s 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) Doe s participant now or will later this year play for any other league or team (Includes Travel Teams)? Yes No If Ye s, League or Te am type :___________________________________________________________________________________________
Pare nt/Guardian 1:_________________ Home ( Cell (
) _____- ______ ) _____- ______ TEXT Yes No Email:_________________________________
Pare nt/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:__________________ 2016 Fees: (Family Discount = $10.00 off each player after the 2 nd player.) Must live in the same household. Discount does not apply to the First 2 players.
Girls/Boys 5/6 - $40.00 Girls: : 7/8 9/10 11/12 13/14 15 to 18 - $70.00 Boys: 7/8 9/10 11/12 13/14 - $70.00 Boys: 15 to 18 - $75.00
Re gistration forms received after March 5 th, 2016 Will be charged a $15.00 late fee. T he 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 Pe rson 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 p articipate 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 person nel 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 t he 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) 2016 Registration, P.O.Box 293 Holland, OH 43528 STYBS Use Only Cash Check No.____________
Amount Paid:___________
Date Rec’d:____________
Initials______________
