2015 Registration Form

2015 Registration Form

Please check off which division you are registering your child for:

BASEBALL

_____ (7 - 8 yrs) Division 1 _____ (9-10 yrs) Division 2

All Girls And Boys

for Division 1 and Division 2

Up front Non-refundable Registration fee $135.00

$50.00 VOLUNTEER FEE, 1 per family $50.00

You will be given four (4) lotto calendars by your coach - $40.00

*Calendar (s) are your responsibility to sell for $10.00.

The money from the calendar that you sell is yours to keep.

VOLUNTEER fee will be returned to you after you complete your hours. $50.00

$ 95.00/player

Name ______

Address ______

Phone ______Shirt Size:______

DOB ______Male ______AGE (as of Dec. 31, 2015)

Parent/Guardian Name ______

Email: ______

Medical Carrier: Medical Condition: ______

Registration $ ______Check # ______Volunteer Fee $______Check # ______CASH ______

A $25.00 FEE AND BANK FEES WILL BE APPLIED FOR ALL RETURNED CHECKS

MEDICAL RELEASE AND PARENT CONSENT FORM

I the parent/guardian of the registrant, a minor or adult registrant of legal age, agree that I and the registrant will abide by the rules of the Fairless Hills Athletic Association, its affiliated organization and sponsors. Recognizing the possibility of physical injury associated with sports and in consideration for the Fairless Hills Athletic Association, accepting the registrant for its programs and activities. I hereby release, discharge and for otherwise indemnify the Fairless Hills Athletic Association, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for the programs, against any claim by or on behalf of the registrant as a result of the registrants participation in the program and/or being transported to or from the same, which transportation I hereby authorize. The above minor has my permission to participate in the Fairless Hills Athletic Association's Sports programs. In consideration of your acceptance of my enrollment, I the player, and we the parents, individually and collectively, intending to legal bound hereby for ourselves and heirs, executors and administrators, waive and release Fairless Hills Athletic Association, their agents and representatives from any and all claims or the rights to damages for injuries or losses suffered by me, the player, directly or indirectly, in training for, or traveling to or from or competing in or while attending any future Fairless Hills Athletic Association functions. I acknowledge the registration fee only includes secondary accident insurance. As the parent or legal guardian of the above named player, I hereby give my consent for medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the live, limb, or well being of my dependent.

Parent/Guardian Signature: ______Date:______