Mt. Gilead Baseball Softball Commission
SIGNUP FORM
NO COACHING REQUEST WILL BE HONORED
Each page must be entirely filled out to be accepted.
PLAYERS NAME: ______
ADDRESS: ______City& Zip Code______
E-MAIL ADDRESS: ______
Phone No. #1 ______Phone No. 2# ______
BIRTHDATE: MONTH______DAY______YEAR______
(Example 3-25-2005)
**** 4 years olds wishing to Sign-up must be 5 on or before August 1 of current year ****
Age as of April 30th Boys ______Age as of January 1 for Girls ______
PARENTS NAME (must include last name) ______& ______
SCHOOL DISTRICT PLAYER ATTENDS: ______
Do you want to be a Head Coach? YES ______NO ______
Do you want to assist a Head Coach? YES ______NO ______
**** A background check form must be filled out for all volunteers ****
LAST YEAR’S COACH: ______
SAME COACH FOR THIS YEAR IF POSSIBLE? ______YES ______NO
POSITIONS PLAYED: ______UNIFORM NUMBER: ______
PLEASE CHECK ONE BELOW AGE GROUP FEE
______Boys T-BALL Baseball 5 6 $65
______Boys COACH PITCH Baseball 7 8 $65
______Boys PEE WEE Baseball 9 10 $65
______Boys LITTLE LEAGUE Baseball 11, 12 & 13 $65
______Boys PONY LEAGUE Baseball 14, 15 16 $65
______Girls 6 UNDER Softball 5 6 $65
______Girls 8 UNDER Softball 7 8 $65
______Girls 10 UNDER Softball 9 10 $65
______Girls 13 UNDER Softball 11, 12 & 13 $65
______Girls 16 UNDER Softball 14, 15 & 16 $65
MAKE CHECKS PAYABLE
Mt. Gilead Baseball Softball Commission or MGBSC
AUTHORIZATION TO CONSENT FOR TREATMENT OF A MI
AUTHORIZATION TO CONSENT FOR TREATMENT OF A MINOR
It’s important to remember that a child under 18 years of age who needs medical, dental, or hospital care cannot be treated without parental permission unless the situation threatens the child’s life or limb. That’s the law.
To ensure that your child receives the proper care in your absence, you can appoint anyone over 18 years of age to authorize your child’s medical care. By completing the form below and leaving it with the person taking care of your child, it will be ready to use in case of a medical emergency.
I hereby grant to ______authority to give an informed
(Name of team coach) Leave Blank
consent for the treatment of ______, ______should
(Child’s name) (Age)
such child require medical care of any nature by reason of any condition or incident, except that the following procedures should not be performed without my consent unless the concurring medical opinion of two physicians is that such procedures are necessary to relieve the suffering or preserve the life or limb of such child and I cannot be reached after reasonable attempts:
a) Major surgery b)______
(Other, if any)
Facts concerning the child’s medical history, including allergies, physical impairments, and medications being taken, to which a physician should be alerted are as follows:
______
______
Our family physician is Dr. ______
Our family dentist is Dr. ______
Our hospital of choice is ______
Our health insurance plan is ______
(If any) (I.D. Number)
This authorization expires at noon on December 1st of Current Year
(Month) (day) (year)
Signature of Parent ______Date ______
Address:______
Phone: ______Other Phone: ______
Witness: ______
Provided as a public service by Morrow County Hospital, 651 W. Marion Rd., Mt. Gilead, Ohio.
Baseball and Softball
Batting Helmet with Faceguard
The Mt. Gilead Baseball Softball Commission will be requiring the use of helmets with faceguards for all girls’ leagues and for boys’ T-Ball, Coach Pitch and Pee-Wee leagues. Each year we receive a donation of free helmets with faceguards for participating in the “Play Hard – Don’t Blink” program. In exchange for this equipment, our teams will need to mandate that all players wear this protective gear. There will be no exceptions for the girls’ leagues or the boys’ T-Ball, Coach Pitch, and Pee-Wee leagues.
The Mt. Gilead Baseball Softball Commission would also like to encourage Little League and Pony League players to wear the helmets with faceguard protective gear. However, this will not be mandatory for these two leagues. Parents will need to sign an acknowledgement form for the Mt. Gilead Baseball Softball Commission to keep on file for the season confirming that they understand that this opportunity is available to them.
We look forward to having a Fun and Safe year!
Thank you!
Mt. Gilead Baseball Softball Commission
I acknowledge that I have received and read the information distributed by the Mt. Gilead Baseball Softball Commission (MGBSC) in regards to the batting helmet with faceguard. I understand the potential risk of not using this piece of protective gear and that every player has access to a helmet with faceguard if they so choose. I will not hold the Mt. Gilead Baseball Softball Commission responsible in the event of an injury due to not wearing the helmet with faceguard only optional in boys Little League and Pony League. Please initial in box.
Please initial in box.
Please initial in box :
Parent Picture Release Form
PHOTOGRAPHS/VIDEO TAPES
Occasionally the newspaper, Mount Gilead Baseball Softball Commission Board Members, and/or parents wish to take photographs or videotapes of children during league games, clinics, or events. Your permission is needed to allow these photographs to be displayed in print, audiovisual, or MGSBC web based media. I further understand that no compensation will be provided for use of any of the photographs or videos.
Please circle one and initial in box:
1. Yes, my child may be photographed or videotaped
2. No, my child may not be photographed or videotaped
Please initial in box :
Participant Waiver of Responsibility Form
I, the undersigned, by participating in baseball/softball sponsored by the Mt. Gilead Baseball Softball Commission, understand and agree that such activities have certain inherent risks that can and do result in injury that can be serious, life limiting and life threating.
I, the undersigned, agree to release the Mt. Gilead Baseball Softball Commission and it’s elected officials and volunteers from all claims resulting from any and all injuries sustained while participating in Baseball/Softball except those that arise out of the sole negligence of the Mt. Gilead Baseball Softball Commission and its officials and volunteers. MGBSC has made available to me the Ohio Department of Health Concussion Information Sheet for Youth Sports.
If the participant is a minor (under the age of 18), a parent or legal guardian must sign this form and initial in all 2 boxes as acceptance of MGBSC guidelines as well.
Name of Participant (Please Print & Sign)
Name of Parent or Legal Guardian (Please Print & Sign)
Name of Witness from Mt. Gilead Baseball Softball Commission (MGBSC)
(Please Print & Sign)
***MGBSC will be offering our 4th Annual Fall Ball this year with more details to come like our Facebook page and website mgbsa.org***
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