Benicia Fastpitch

Player Registration Form 2016

Parent Information

Parent/Guardian #1
Please List Relationship / Parent/Guardian #2
Please List Relationship
Name / Name
Address / Address
City/State/Zip / City/State/Zip
Home Phone / Home Phone
Cell/Work Number / Cell/Work Number
Player lives with:
□ Parent/Guardian #1
□ Parent/Guardian #2
□ Both /  Parent intends to serve as Manager or Coach
 Player has sibling playing in same division requesting
Same or different team/s. (circle one)

Medical Information

Physician Name/City______Phone No.______

Insurance Company______ID Number______

List any Medical Conditions______List any Allergies______

Emergency Contact Information

Name______Contact No.______

Relationship to player (uncle, grandparent, etc):______

Parent/Guardian Consent and Release of Liability and Consent of Medical Treatment of Minor:

I, the undersigned, being a parent and/or legal guardian of the above named player, do hereby grant permission for her participation in the sport of Softball being conducted by the Benicia Fastpitch. I/We assume all risks and hazards incidental to such participation including transportation to and from the activities, and I/We do hereby waive, release, absolve, indemnify and agree to hold harmless Benicia Fastpitch, the City of Benicia, Benicia Unified School District and all organizers, sponsors, supervisors, participants and persons transporting my/our child to and from activities for any claim arising out of an injury to my/our child, whether the result of negligence or for any other cause, except to the extent and in the amount covered by accident or liability insurance. I/We know that participation in softball may result in serious injury to my/our child; protective equipment does not prevent all injuries to players. In the event of injury, I/We, being parent and/or legal guardian of the above named player, give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.

Signature______Date______

~CONTINUED~PLEASE COMPLETE OTHER SIDE~

Please initial on the lines below that you have read, understand, and agree with the following statements.

______Photo Release:I authorize Benicia Fastpitch to photograph and publish photographs of my child in the newspaper, softball publications and our website.

______Volunteer Deposit: Benicia Fastpitch softball no longer requires a volunteer deposit OR for families to fulfill 4 hours of volunteering during the season.

______Parental Code of Ethics:I hereby pledge to provide positive support, care, and encouragement for my child participating in youth sports by following this Code of Ethics Pledge.

  • I will encourage good sportsmanship by demonstrating positive support for all players, coaches, and officials at every game, practice or other youth sports event.
  • I will place the emotional and physical well-being of my child ahead of a personal desire to win.
  • I will insist that my child play in a safe and healthy environment.
  • I will support coaches and officials working with my child, in order to encourage a positive and enjoyable experience for all.
  • I will demand a sports environment for my child that is free of drugs, tobacco and alcohol, and will refrain from their use at all youth sports events.
  • I will remember that the game is for youth – not adults.
  • I will do my very best to make youth sports fun for my child.
  • I will ask my child to treat other players, coaches, fans, and officials with respect regardless of race, sex, creed or ability.
  • I promise to help my child enjoy the youth sports experience by doing whatever I can, and such as being a respectful fan, assisting with coaching, or providing transportation.

I pledge to “honor the game.” I understand the importance of setting a good example for my child. No matter what others may do, I will show respect for all involved in the game including coaches, players, opponents, opposing fans, and officials. I understand that official make mistakes. If the official makes a “bad” call against my team, I will Honor the Game and be silent!

Benicia Fastpitch cannot guarantee the division, team, or coach your child will play for.

No registration refunds will be issued after opening day.

I understand and agree to all of the above items.

Signature______Date______

For Office Use Only:
Division:
Rookie Farm Junior Minor Senior / Payment Information:
Check #______or Cash
Amount: $______or Scholarship