Recreation Registration

Recreation Registration

Player Info

Player’sName:

BirthDate:

Parent/GuardianName:

Address:

HomePh:

CellPh:

Alt.Emrg.Ph:

E-Mail:

Pleaseenterthenameofanysiblingsplayingandtheirage:

Experience(yearsasapplicable)

Recreation:

Travel:

Shirt Size (Pleasecirclesize) YS YM YL YXL AS AM AL AXL

Shoe size (Pleasecirclesize) 3 & under 4-7 8 & up

Medical Info

Does your child have a physical condition that may be aggravated by participation in this program? Yes or No (pleasecircleone)

Ifyes,adoctor’snoteMUSTbeprovidedtotheleaguepriortoparticipation.

Recreation Program(check one, all ages are of January 1, 2018 except the minor division which is 4/1/18): Fee

□ Minor Division (Birth Years 2011/2012) ...... $ 35.00

□ Major Division(Birth Years 2009/2010) ...... $ 60.00

□ Junior Division(Birth Years 2007/2008) ...... $ 65.00

□ Senior Division(Birth Years 2004/2005/2006)...... $ 75.00

*A $25.00 late registration fee will be applied to all registrations received after3/16/18

Sponsorship

Wouldyouoryouremployerbeinterestedinsponsoringateamfortheseason? Yes or No

Areyouinterestedinhelpingoutthisseason?

Volunteer

 HeadCoach  AssistantCoach  VolunteerActivities(ZitiDinner,Concession,etc.)

Isyourdaughterinterestedinpitching? Yes or No

Whileallgirlsmaybegivenachancetotrypitchingduringpractice,onlygirlswho have attended at least two hours of leagues paid and/or free pitching clinics or privatepitchinglessonswithinthelastcalendaryearwillbeeligible.

Isyourdaughterinterestedinplayingorareyouinterestedinlearningmoreaboutourtravel program? Yes or No

Travel Program

□8U Birth Year 2009 & 2010

□ 10U Birth Year 2007 &2008

□ 12U Birth Year 2005 & 2006

□ 14U Birth Year 2003 & 2004

□ 16U Birth Year 2001 & 2002

Areyouinterestedinbeingacoachforourtravelprogram? Yes or No

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I, (Parent and/or Legal Guardian) request that my child _ (Player) be allowed to participate in this program. I agree to accept responsibility for the insurance deductible and/or uncovered medical, dental, hospital and doctor bills that may incur from participation of my child in the softball program. I will not hold Miss Scotties Softball Inc. inclusive of its Board, Directors, Managers, and Coaches responsible in any way. I further acknowledge all the above information.

ASSUMPTIONOFRISK:IagreetoindemnifyandholdharmlesstheTownofMaltaParks& RecreationDepartment,theTownofMalta,theMaltaAthleticAssociation,MissScotties Softball,itsemployees,personnel,independentcontractorsandvolunteersfromanyandall liabilityforinjuriesordamageswhichmayariseasaresultofparticipatinginthisactivity.I assumeallrisksandhazardsincidentaltoparticipationonbehalfofmyselformychildand recognizemychildisphysicallyandmentallyfittoparticipateandhavenotbeenadvised

otherwisebyaphysician.IalsounderstandthatIamresponsibletodeterminewhetheritissafe formychildtoparticipateinthisprogramandassumetheriskbyenrollingmychildinthe

program.Idoherebywaive,relinquish,release,discharge,andholdharmlessfromanyandall

liability,foranyphysicalormentalinjuryoraggravationofanypre-existingillness,handicap, death,lossofenjoyment,oranyotherharmorlossofnaturewhichmaybesustainedbymeor mychildwhileparticipatinginthisactivity.IfurtheragreethatthecoachesorBoardpersonnel mayactinanemergencyasbestfitsthesituationintheeventmyemergencycontactcannotbe reached.

Parent/GuardianName(print) Signature Date

WitnessName(print) Signature Date