FLUVANNA YOUTH BASEBALLSpring 2017

Buddy Ball/T-BALL / ROOKIE / MINOR / MAJOR / JR. BABE RUTH

PLEASE INDICATE BELOW HOW YOU CAN HELP OUR LEAGUE BY VOLUTEERING:

Manager/Coach___ Team Parent ___ Committee ____ Special Events ____ Sponsorship___

Registrant’s Last Name / First Name / Date of Birth Grade
Street Address / Home Phone / Players age as of April 30st 2017
City,State,Zip / Circle: Buddy Ball T-BALL ROOKIE MINOR
MAJOR BABE RUTH
( Must be drafted except Buddy Ball and T-Ball) / MEDICAL PROBLEMS:
Player’s Shirt Size: Youth S M L / Adult S M L XL XXL
Adult small is a youth XL / Hat Youth Adult
PARENT #1 (Other Legal Guardian) INFORMATION / PARENT #2 (Other Legal Guardian) INFORMATION
First & Last Name / First & Last Name
Home Phone / Home Phone
Work Phone / Work Phone
Cell Phone / Cell Phone
Email Address (please print clearly) / Email Address (please print clearly)
LIABILITY RELEASE
In case of injury to my child at baseball practices or games, I do hereby authorize transportation of said child by Fluvanna County Rescue Squad to the UVA or Martha Jefferson Hospital Emergency Room and also authorize emergency treatment of said child by emergency room staff at their discretion until my arrival at emergency room. I understand that I will be notified as soon as possible if any such incident should occur. I thoroughly understand the nature of the activity listed above and the risks and dangers associated with it. I also understand that it is the duty of each participate to exercise due care in the performance of this activity for the safety of him/her and the other participants.
In consideration of my/the participants being allowed to enroll in this activity, I hereby release, indemnify, and hold harmless the Fluvanna Youth Baseball League, the County of Fluvanna, its employees, agents, operators, and instructors from any and all claims, demands, costs, charges, and expenses for harm, injury, damage, or loss which may be sustained by my/the participant as a result of/or relating to participating in this activity.
In witness whereof, I have executed this liability release as my own free act.
______
Signature of Parent/Guardian Date
FYB ENCOURAGES PARENT/GUARDIAN TO NOT LEAVE PARTICIPANT WITHOUT A FAMILY MEMBER PRESENT AT ALL TIMES. Initial ___

REGISTRATION FEE: $0 (Buddy Ball) $60 (T-Ball 4-5) $70 (T-Ball 5-6) $85 (Rookie) $90 (Minor / Major /Jr. Babe)

FYB USE ONLY: Paid $_____ Check (#_____) Cash ____ Not Paid ____ Sponsorship _____

($10 off for each sibling registration)

$15LATE FEE BEGINNING February 6th

Registration by mail, send to:Registration on-line($4 on-line registration fee will be included)

FYB

P.O. Box 431

Palmyra, VA 22963 FORMS ARE NOT ACCEPTED WITHOUT PAYMENT