Pecatonica Sports Association 2009 T-Ball / Coach Pitch Season Registration Form

Name: __________________________________________________________ Please Circle: Male / Female

Address:______________________________________________________________________________

Date of Birth: ____________________________ Grade Entering in Fall 2009:______________

Current School: _________________________________________________________________

Mother’s Name: ____________________________ Phone # ________________ Cell# ______________

Mother’s Address if different than above: __________________________________________________

Mother’s E-Mail Address : _______________________________________________________________

Father’s Name: _____________________________ Phone # _________________ Cell# _____________

Father’s Address if different than above: ___________________________________________________

E-Mail Address: ________________________________________________________________________

NOTE: Seven (7) year olds have an option to play one more year of coach pitch or move to player pitch.

For player pitch, please use the other form.

Age deadline is May 1st

Shirt Size: YOUTH – S – M – L Registration Fee: $35.00

Medical Release

I, parent or guardian of (player’s name)________________________________, hereby give approval for participation in any and all

Pecatonica Baseball league activities. I hereby grant permission to managing personnel or other league representatives to authorize and

obtain medical care from any licensed physician, hospital or medical clinic should the player become ill or injured while participating in league

activities when neither parents nor guardian is available, either in person or by phone, to grant authorization for emergency treatment. I

assume all risks and hazards incidental to such participation, including transportation to and from the activities: and, do hereby waive, release,

absolve, and indemnify and agree to hold harmless the Pecatonica Sports Association, Pecatonica Baseball League, the organizers,

sponsors, supervisors, participants, and persons transporting the player to and from activities, for any claim arising out of an injury to the

player.

SPECIAL NOTE: Please indicate any special needs of the player being registered that would be necessary or helpful to know in the event of

an emergency (ie: allergies, special medications, other conditions that are vital to medical care.)

Player Allergies: _______________________________________________________________________

Other Medical Information: ______________________________________________________________

Parents/Guardians Signature: ___________________________ Relationship: ____________________

Date: ________________________________

If you are interested in assisting with organizational activities or coaching, please indicate below: name, phone, and interest.(coach, assistant coach, umpire, general help as needed)