olmsted travel baseball association AWS
OLMSTED TRAVEL BASEBALL ASSOCIATION P.O. Box 38204, Olmsted Falls, Ohio 44138 Facebook: OlmstedTravelBaseball Twitter: @OlmstedBaseball Website: www.olmstedtravelbaseball.com 2016 REGISTRATION FORM CVBA and Puritas Team Fees: $205 Fees due to team managers by 10/31/2015 MAKE ALL CHECKS PAYABLE TO “OLMSTED TRAVEL BASEBALL ASSOCIATION”
2015 Coach’s Name
League(Circle One)
Player Name
Date of Birth
Street Address
City/Zip Code
Mother’s Name
Father’s Name
Mother’s Phone Number
Father’s Phone Number
Mother’s E-mail
Father’s E-mail
CVBA Puritas
Age on May 1, 2016_____
********************************************************* For OTBA Use Only ********************************************************** Payment:
Cash ____________
Check # ____________
Amount $_______________
Registration received by:
Mail ____________
Sign-up ____________
Date Rec. _______________
Birth Certificate On File: Y N BOARD OF DIRECTORS President: Bob Kelley 440-376-0790 Vice President: Bob Wikle 440-241-6086
Treasurer: Bob Zalac 216-235-9169 Secretary: Brian Gillette 216- 640-0882
OLMSTED TRAVEL BASEBALL ASSOCIATION P.O. Box 38204, Olmsted Falls, Ohio 44138 Facebook: OlmstedTravelBaseball Twitter: @OlmstedBaseball Website: www.olmstedtravelbaseball.com RELEASE & CONSENT FOR MEDICAL TREATMENT FOR MINOR _______________________________________________________________________________________________________________ Registrant’s Name (please print)
____________________________________________________________________________________________________ Street Address City, State, Zip
____________________________________________________________________________________________________ Primary Phone Number Secondary Phone Number
____________________________________________________________________________________________________ Emergency Contact Name Emergency Contact Phone
RELEASE I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the Olmsted Travel Baseball Association (OTBA), its affiliated organizations, and sponsors. Recognizing the possibility of physical injury associated with baseball and in consideration for the OTBA, accepting the registrant for its baseball programs and activities (the Program), I hereby release, discharge, and/or otherwise indemnify the OTBA, its affiliated organizations, and sponsors, their employees, volunteers and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from same, which transportation is hereby authorized.
CONSENT FOR MEDICAL TREATMENT As the parent or legal guardian of the registrant, I hereby give my consent for emergency care prescribed by a duly licensed Doctor of Medicine or Doctor or Dentistry. This care may be given under whatever conditions as necessary to preserve the life, limb, or well being of my dependent.
CONSENT FOR ELECTRONIC COMMUNICATIONS OTBA relies on electronic communication to notify the membership of current events within the organization. As a member of the organization, I hereby agree to allow OTBA to use my e-mail address for purposes of communicating current events within the organization to me.
_______________________________________________ Manager Name (please print)
_________________________________________________ Parent or Legal Guardian (please print)
_______________________________________________ Manager Signature / Date
_________________________________________________ Parent Signature
_______________________________________________ Assistant Manager’s Name (please print)
_________________________________________________ Date
__________________________________________ Assistant Manager Signature / Date BOARD OF DIRECTORS President: Bob Kelley 440-376-0790 Vice President: Bob Wikle 440-241-6086
Treasurer: Bob Zalac 216-235-9169 Secretary: Brian Gillette 216- 640-0882
2015 Coach’s Name
League(Circle One)
Player Name
Date of Birth
Street Address
City/Zip Code
Mother’s Name
Father’s Name
Mother’s Phone Number
Father’s Phone Number
Mother’s E-mail
Father’s E-mail
CVBA Puritas
Age on May 1, 2016_____
********************************************************* For OTBA Use Only ********************************************************** Payment:
Cash ____________
Check # ____________
Amount $_______________
Registration received by:
Mail ____________
Sign-up ____________
Date Rec. _______________
Birth Certificate On File: Y N BOARD OF DIRECTORS President: Bob Kelley 440-376-0790 Vice President: Bob Wikle 440-241-6086
Treasurer: Bob Zalac 216-235-9169 Secretary: Brian Gillette 216- 640-0882
OLMSTED TRAVEL BASEBALL ASSOCIATION P.O. Box 38204, Olmsted Falls, Ohio 44138 Facebook: OlmstedTravelBaseball Twitter: @OlmstedBaseball Website: www.olmstedtravelbaseball.com RELEASE & CONSENT FOR MEDICAL TREATMENT FOR MINOR _______________________________________________________________________________________________________________ Registrant’s Name (please print)
____________________________________________________________________________________________________ Street Address City, State, Zip
____________________________________________________________________________________________________ Primary Phone Number Secondary Phone Number
____________________________________________________________________________________________________ Emergency Contact Name Emergency Contact Phone
RELEASE I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the Olmsted Travel Baseball Association (OTBA), its affiliated organizations, and sponsors. Recognizing the possibility of physical injury associated with baseball and in consideration for the OTBA, accepting the registrant for its baseball programs and activities (the Program), I hereby release, discharge, and/or otherwise indemnify the OTBA, its affiliated organizations, and sponsors, their employees, volunteers and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from same, which transportation is hereby authorized.
CONSENT FOR MEDICAL TREATMENT As the parent or legal guardian of the registrant, I hereby give my consent for emergency care prescribed by a duly licensed Doctor of Medicine or Doctor or Dentistry. This care may be given under whatever conditions as necessary to preserve the life, limb, or well being of my dependent.
CONSENT FOR ELECTRONIC COMMUNICATIONS OTBA relies on electronic communication to notify the membership of current events within the organization. As a member of the organization, I hereby agree to allow OTBA to use my e-mail address for purposes of communicating current events within the organization to me.
_______________________________________________ Manager Name (please print)
_________________________________________________ Parent or Legal Guardian (please print)
_______________________________________________ Manager Signature / Date
_________________________________________________ Parent Signature
_______________________________________________ Assistant Manager’s Name (please print)
_________________________________________________ Date
__________________________________________ Assistant Manager Signature / Date BOARD OF DIRECTORS President: Bob Kelley 440-376-0790 Vice President: Bob Wikle 440-241-6086
Treasurer: Bob Zalac 216-235-9169 Secretary: Brian Gillette 216- 640-0882
