Umpqua Valley Baseball & Softball

Player Registration Form

Requested Division of Play: Request Player Level of Play (Player assessment is required for Rookie level and up)

Baseball Softball Babe Ruth

£ T Ball (4-6) $105 £ Minor Soft B. (9-10) $115 £ Babe Ruth Baseball (13-15) $115

£ Machine Pitch (7-8) $105 £ Major Softball (10-11) $115

£ Minors Baseball (8-9) $105 £ Senior Softball (13-16) $115 Family

£ AAA Minor Baseball (10-11) $115 £ Family 3 or more players
£ Major Baseball (11-12) $115

All Fees are NON refundable. Maximum Out of Pocket Expense for family is $260. Please check division and family box if applying for family discount.

Player Information:

First Name: ______Last Name:______Gender: £M £F

Date of Birth: ______School Attending: ______Grade: ______

Mailing Address: ______City: ______Zip:______

Father's/Guardian’s Name: ______Phone: ______

Email: ______

Mother's/Guardian’s Name: ______Phone: ______

Email: ______

If you know anyone interested in coaching or umpiring? Name: ______Phone #:______

Uniform Sizing:

Circle one for shirt and one for pants (this is just a request, uniforms will be issued as available)

Shirt: Child - XS S M L XL / Pants: Child - XS S M L XL
Adult - S M L XL XXL / Adult - S M L XL XXL


By signing below I affirm that I give permission for the young person named on this form to participate in all Umpqua Valley Baseball-Softball sanctioned programs, practices, games, events, clinics, tournaments, or events. In addition, I authorize Umpqua Valley Baseball-Softball to use the young person's image in video, photo, or any other medium for educational, fundraising, or promotional purposes and I understand that such imagery may be published in a variety of ways including, but not limited to, print and electronic formats. Additionally, I give permission to release the young person's name to media for league purposes.

Authorized Signature: ______Date: ______

......
For office use only Date: ______

Reg. Fee $______Scholarship Approved: £ Yes £ No Amount approved: $______

Received: $______Cash/Check UVB-S Agent ______

Notes: ______

Umpqua Valley Baseball & Softball PO Box 2025 Roseburg, OR 97470 – 2014 Registration Form