ALABASTER YOUTH BASEBALL 2011 Spring Registration Form

Child’s Name: ________________________________________ Date of Birth: __ / /_____

Division: (circle one)

Minor (Player Pitch – age 9/10) Major (Player Pitch – age 11/12) Metro (Player Pitch – age 13/14)

Registration Fees: $160.00 for 1st child NO Checks Accepted Non-Resident Fee: 10%
$130.00 for 2nd child Multi Child Discount: 10%
$100.00 for 3rd child
$100.00 for T-Ball (age 5)

NEW ___ or RETURNING ___ Baseball Player (circle one) Male or Female AGE as of April 30, 2011 _____

Where are you zoned for School? _______________ Baseball Experience (yrs. played) _____

Address: ___________________________________________________________________________
Mailing Address City State Zip

Birth Certificate is: Attached____ Not Attached____ On-file____ Home Phone: ___________________

Father’s Name: ________________________________ Work No.: _________________ Cell No.: _________________

Email Address: _____________________________________________________________________________________

Would you be interested in coaching: (circle one) HEAD COACH ASSISTANT COACH

Mother’s Name: ________________________________ Work No.: _________________ Cell No.: ________________

Email Address: _____________________________________________________________________________________

Would you be interested in coaching: (circle one) HEAD COACH ASSISTANT COACH TEAM MOM

I DO NOT want my child to play for the following Coach:

Reason:

I hereby give my approval for the above named child to participate in all baseball activities during the current season.
I am the parent or legal guardian of the child that I have registered. I certify that all information given is correct.

_______________________________________________________________ _____________________________________________
Authorized Parent/Guardian Signature Date

YOU MUST COMPLETE THE OTHER SIDE!

Player’s Name: __________________________________

Per Alabaster City Ordinance 95-381 I understand: Any person who engages in arguments, uses abusive language, harasses
game or league officials or exhibits any unsportsmanlike behavior may be barred from parks and/or prosecuted.
__________
INITIALS

I/We, the parent(s)/guardian(s) of the above named child, authorize the City of Alabaster to publish pictures of my/our child on
the local website. Individual pictures or names identifying pictures will not be used. _____ _____
YES NO

I/We, the parent(s)/guardian(s) of the above named child, understand the Refund Policy: If a player requests refund prior to
team assignment, 50% of the registration fee will be refunded. No refund will be issued after a team assignment has
been made. ____________
INITIALS

I/we, the parent(s) and/or legal guardian(s) of the above named candidate, know that participation in Alabaster Youth Sports may result in
serious injury(ies), and moreover protective equipment does not prevent all injuries to participants. Therefore I do in consideration of being
allowed to participate in the above named activity, hereby assume all responsibility for said activity and/or child. I authorize the City of Alabaster
Parks and Recreation Department (CAPRD) to obtain necessary medical care and treatment for the participant for any illness or injury occurring
during the activity period, but I understand CAPRD is NOT assuming a duty to obtain medical treatment, make medical decisions, or render
medical care or treatment to the participant. I understand that CAPRD has NO ACCIDENT or MEDICAL PAYMENT INSURANCE COVERAGE
for the participant and I agree to pay all reasonable medical costs incurred if treatment is obtained. I release, indemnify and agree to hold
harmless, CAPRD and its agents, elected officials, servants, and employees from all claims, action, causes of action and rights of recovery or
reimbursements of any type that any participant has or may have in the future which arise from or are related in any manner to the activity(ies)
(including, but not limited to, claims of bodily injury and property damage or loss), and I assume all risks and hazards incident to such
activity(ies) and transportation to and from the same. This instrument is signed both individually and on behalf of the participant(s) present at
activity(ies). ____________
INITIALS

Parent or Guardian Authorization:

Family Physician: _________________________________________________ Phone: _______________________

In Case of an Emergency, contact: (Someone other than parents)

Name: _________________________________________ Relationship to Player: _____________________________________

Cell Phone: _______________________ Home Phone: _______________________ Work Phone: _______________________

Please list any allergies/medical problems, including those requiring maintenance medications (i.e. diabetic, asthma, seizure disorder).
Include medical diagnosis, medication, dosage, and frequency of dosage.

The purpose of the above listed information is to ensure that medical personnel have details of any medical concern
which may interfere with or alter treatment.
_______________________________________________________________ _____________________________________________
Authorized Parent/Guardian Signature Date
FOR OFFICE USE ONLY
Amount Paid ___________________

Date Paid ___________________

Cash/Debit/Visa/Master Card ___________________

Receipt No. OR Last 4 digits of Charge Card ___________________

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