FORM IS DOUBLE SIDED

PAIDCash: $______Check: $______#______Birth Cert. ______

2015 BERWICK YOUTH BASEBALL REGISTRATION

Sign-ups for girls & boys ages 4-15 will be held on January 27thand 29thand February 3rd, 5th, 10th, and 12th from 6-9pm at the Berwick Town Hall. This applies to the age of the child as of April 30, 2015.Birth certificates arerequired for all 1st year players in this program. Registrations received after 3/16/15will be honored if space is available. For additional info, Please call (603)781-6098 or visit our website at berwickyouthbaseball.baberuthonline.com.

Please check which league applies to your child:(MAX COST OF $130 PER FAMILY, N/A for BABE RUTH)

____ T-BALL LEAGUE (Ages 4-6): Cost $55

____ ROOKIE LEAGUE (Ages 6-8): Cost $65

____ MINOR LEAGUE (Ages 8-11): Cost $75

____ MAJOR LEAGUE (Ages 10-12): Cost $75

____ BABE RUTH LEAGUE (Ages 13-15): Cost $100

Please make checks payable to: BERWICK YOUTH BASEBALL

Payment is required with registration. A late fee of $30.00 will be added for signups after 3/16/15 Mailing address: BYB, P.O. Box 55, Berwick, ME 03901

PARTICIPANT INFORMATION (Please print)

LAST NAMEFIRST NAMEAGE (as of 4/30/15)DATE OF BIRTH

MAILING ADDRESS (Residential Address, town, state and zip code)

1.PARENT/GUARDIAN NAMEPHONE NUMBERE-MAIL ADDRESS

2.PARENT/GUARDIAN NAMEPHONE NUMBERE-MAIL ADDRESS

PERSON TO NOTIFY IN CASE OF EMERGENCYPHONE NUMBER

LIST ANY MEDICAL PROBLEMS CHILD MAY HAVE (such as allergies, asthma, etc.)

NOTE: Shirts are being purchased this year. You will be responsible for a $15 replacement fee if your child’s shirt doesn’t fit.

PLAYERS SHIRT SIZE: YOUTH ADULT (CIRLCE ONE) XS S M L XL 2XL (CIRCLE ONE)

PARENTAL SUPPORT IS NEEDED! Please circle each area where you can help.

Coach

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Asst Coach

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Team Parent

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Field Maint.

Concessions

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Sponsor

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Umpire

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Board

INSURANCE WAIVER AND LIABILITY RELEASE

It is understood that this insurance waiver and release is in effect and applies during that period of time that the Berwick player is participating in Berwick Youth Baseball/Babe Ruth League.

The following conditions are acknowledged and accepted by the parent or guardian of the player.

  1. No player can participate in Berwick Youth Baseball/Babe Ruth League without adequate coverage as provided by a protective accident insurance policy.
  1. The player is presently protected by an adequate insurance policy, which contains the necessary requirements and provides coverage for injury resulting from participation in the athletic activity named herein; therefore, the MSAD #60 available insurance plan for students does not qualify.
  1. If the child is not covered by an insurance policy, Berwick Youth Baseball/Babe Ruth League will supply coverage to any child not already covered by another policy.

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Signature of Parent/Guardian Date Insurance Company

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Policy Number

I, the parent/guardian of the registrant, a minor, agree that I, the parent/guardian, and the registrant will abide by the Constitution and by-laws of Berwick Youth Baseball/Babe Ruth League and its affiliated sponsors. Recognizing the possibility of physical injury associated with baseball, I hereby release, discharge and/or otherwise indemnify, any claim by or on behalf of the registrant’s participation in the program, and/or being transported to or from same, which transportation I hereby authorize. I also authorize Berwick Youth Baseball and its sponsors to utilize my child’s photo in publication pertaining only to the participation in Berwick Youth Baseball and the events of the program.

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Name of Parent/Guardian (PRINT)

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Parent/Guardian Signature Date