West End Youth Baseball Association
P.O. Box 51
Naturita, Co 81422
REGISTRATION –2016
Player Information: Player’s Name:______Age:______
Address:______Date of Birth:______Grade Level Fall of 2015: _____
Uniform (Specify Adult or Youth Size): Shirt Size:______Chest:______Shoe Size:______
Pant Size:______In Seam:______Waist:______
Pants, shirt, , belt and hat will be provided for ages 9 and above. T-Ball/Coach Pitch/Machine Pitchwill be provided shirts and hats.
Guardian information:
Mother’s Name: ______Contact Numbers:______home______cell email:______
Father’s Name: ______Contact Numbers: ______home ______cell email:______
Programs/Fees: Please mark one. Fees are due at the time of registration. A $5.00 family discount for each child enrolled after the 1st. Scholarships are available upon approval of the board. All scholarship recipient(s) must participate in all fundraisers, field cleanup and help with concessions.Make checks payable to: WEYBA
T-Ball/Coach Pitch - $35.00 Minors (Ages 9-10) - $90.00Juniors (Age 13) - $90.00 (Ages 4-5) (Ages 6-7)
Machine (Ages *7-8) - $35.00Majors (ages 11-12) - $90.00 Juniors (14-15) - $90.00
*7 yr. olds MUST have played 1 yr of Coach Pitch
No registration will be accepted after April04, 2016.
1.I/We, the parents/guardians of the above-named candidate forthe West End Youth Baseball Association, hereby give my/ourapproval to participate in anyand all Leagueactivities.
2.I/Weknow that participation in baseball mayresult in serious injuriesand protective equipment does not prevent all injuries to players, and do hereby waive, release,absolve, indemnify,and agreeto hold harmless theWest End Youth Baseball Association, the board, the organizers, sponsors, supervisors, participants,and persons transportingmy/our child to and from activities from anyclaim arising out of anyinjuryto my/our child whetherthe result of negligenceor foranyother cause.
______
(Parent/Guardian Signature) (Date)
I would be interested in helping the League in some capacity:
Manager Asst. Coach Other Team Sponsor Field Maintenance Fundraising/Concessions
LEAGUE USE ONLY:
Check #______Family Plan: ______Recv’d By: ______Date: ______
Cash Amount Received:______
This Medical Form must be carried by the Team Manager at alltimes (practices and games) in the event medical treatment fora player is required and the parent/guardian is not available.
Player: ______Date of Birth: ______
League Name: West End Youth Baseball Association
Parent or Guardian Authorization:______
In case of emergency, if family physician cannot be reached, I hereby
authorize the player named above to be treated by Certified Emergency
Personnel. (e.g. EMT, First Responder, E.R. Physician).
Family Physician: ______Phone: ______
Address: ______
Dentist: ______Phone: ______
Address: ______
Hospital Preference: ______
In case of emergency contact:
______
Name Phone Relationship to Player
______
Name Phone Relationship to Player
Medical Information
Please note any medical conditions or allergies (including food allergies) we need to know about the participant:
ANY MEDICAL PROBLEMS: CIRCLE YES OR NO
If yes, please list any allergies/medical problems, including those that require maintenance medication. (e.g. Diabetic, Asthma, Seizure Disorder)
please explain:______
ALLERGIC TO ANY DRUGS: CIRCLE YES OR NO
If yes, please list the drugs:______
Concussion Information
HAS THE PLAYER EVER HAD A PREVIOUS CONCUSSION? CIRCLE YES OR NO
If yes, please list any previous concussions and dates they took place.
______
The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.
______
Authorized Parent/Guardian SignatureDate
*I agree that I am the authorized parent/legal guardian, and I have legal capacity to agree to all terms in this document
Registration forms and payment can be mailed our WEYBA address or turned in to the school office.
Brianne Bonacquista 864-7109 () OR Tammi Magallon (970) 576-9244
2016 Competitive Sports
Baseball Liability Form
I, the undersigned, being the parent or legal guardian of______,
Child/ Children’s Name(s)
completely understand the risks involved in and do hereby consent for my child (children) to participate in any of the activities, games, practices or tournaments ("Baseball Program") entered into and sponsored by the West End Youth Baseball Associationand Montrose West Recreation and to use the facilities at the Naturita Town Park or any other in-state or out-of-state facility designated as the location for team organized activities, practices or games. I specifically consent to allow my child to participate in the Baseball Program as a member of the Team, and to the fullest extent permitted by law, I hereby Release, Waive and Covenant Not to Sue, and further agree to Indemnify, Defend and Hold Harmless the following parties: the City of Naturita, Colorado, the State of Colorado, the Baseball Officials, Sponsors, Promoters and Organizers; any Property Owners, Law Enforcement Agencies or Public Entities providing support for the Baseball Program; and each of their respective parent, subsidiary and affiliated entities, officers, directors, partners, shareholders, members, agents, employees, volunteers, successors and assigns (collectively, the “Released Parties” or “Event Organizers”), with respect to any liability, claim(s), demand(s), cause(s) of action, damage(s), loss or expense (including court costs and attorney’s fees) of any kind or nature (“Liability”) which may arise out of, result from, or relate in any way to mine or my child’s participation in the Baseball program, including claims for Liability caused in whole or in part by the negligent acts or omissions of the Released Parties. I further agree that if, despite this Agreement, I, or anyone on the my behalf, makes a claim for Liability against any of the Released Parties, I will indemnify, defend and hold harmless each of the Released Parties from any such Liabilities which any may be incurred as the result of such claim.
I hereby warrant that I have read the Baseball Team Waiver of Liability carefully, understand its terms and conditions, acknowledge that I will be giving up substantial legal rights by signing it, and intend for my signature to serve as confirmation of my complete and unconditional acceptance of the terms, conditions and provisions of this Agreement. This Agreement represents the complete understanding between me and the Event Organizers regarding these issues and no oral representations, statements or inducements have been made apart from this Agreement. If any portion of this Agreement is held to be unenforceable, invalid or overly broad, I agree that the remaining terms and provisions of this Agreement will continue in full legal force and effect.
I have the authority to sign the Baseball Team Waiver of Liability on behalf of my above-named Child/Children.
Parent/Guardian Signature ______
Printed name______Date______