JARVIS MINOR BALL SOFTBALL REGISTRATION

JARVIS MINOR BALL
SOFTBALL REGISTRATION
PLEASE PRINT CLEARLY
AGE BY
DEC. 31 OF
CURRENT
YEAR
MALE
FEMALE
NAME OF CHILD
HOME TELEPHONE #
DATE OF BIRTH MM/DD/YYYY
LOT #
911 ADDRESS
CONC#
TOWN
MOTHER'S NAME
FATHER'S NAME
MOTHER'S CELL # /WORK #
FATHER'S CELL # / WORK #
PLEASE INITIAL
PLEASE INITIAL FOR THE FOLLOWING
YES
NO
I HEREBY GIVE PERMISSION FOR PICTURES OF MY CHILD TO BE USED ON THE JARVIS MINOR BALL
WEBSITE WHILE SAID CHILD IS PARTAKING IN JARVIS MINOR BALL ACTIVITIES.
I UNDERSTAND THAT HELMETS ARE A MANDATORY PART OF MY CHILDS UNIFORM AND WILL
ENSURE THAT HE/SHE HAS A WELL MAINTAINED ONE.
I UNDERSTAND THAT MY REGISTRATION FEE IS FOR LEAGUE PLAY ONLY AND THAT THE ORSA'S ARE
AT THE DISCRETION OF THE COACH/MANAGER
I AM INTERESTED IN PARTICIPATING WITH THE EXECUTIVE OF THE JARVIS AMATEUR ATHLETIC
ASSOCIATION.
I AM INTERESTED IN HELPING COACH A JARVIS MINOR BALL TEAM.
WHICH TEAM
I HAVE COMPLETED THE VOLUNTEER FORM
I HAVE COMPLETED THE MEDICAL INFORMATION SHEET
I HEREBY RELEASE AND ABSOLVE THE JARVIS AMATEUR ATHLETIC ASSOCIATION, COACHES, JARVIS
LIONS, HALDIMAND COUNTY OR THE JARVIS LIONS PARK STAFF FROM ANY RESPONSIBILITY DUE TO
INJURY BY PARTICIPATING IN ACTIVITIES OR SPORTING EVENTS.
TEAM PLAYED FOR LAST YEAR
E-MAIL ADDRESS
E-MAIL ADDRESS
DATE
SIGNATURE OF PARENT OR GUARDIAN
JARVIS MINOR BALL USE ONLY
REGISTRATION AMOUNT
TEAM
COMMENTS
NON-VOLUNTEER FEE
TOTAL PAID
REGISTRAR'S INITIALS
CHEQUE #
RECEIPT #
CASH