Chesterfield Baseball Club Registration
I, the parent or guardian of the above named candidate, do hereby give my approval to his/her
participation in any and all of the activities of the Chesterfield Baseball Clubs, Inc. during the
current season. In case of injury to my child, I do hereby release, absolve, indemnify, and hold
harmless the Chesterfield Baseball Clubs, Inc. (sponsors of the league), team sponsors,
supervisors, managers, and assistant managers and/or all of them and waive all claims against any
or all of them. The above waiver of damages does not apply to the benefits under the insurance
policy.
Each child will be covered by a supplementary group accident insurance policy both during
practice and the playing season. Should the above named candidate become a member of the
official roster of a team in the Chesterfield Baseball Clubs, Inc. league, I do hereby agree to pay
the association/league the cost of participation.
I will furnish, upon request by League Officials, a copy of the birth certificate of the above named
candidate.
I agree to return, upon request, the uniform and other equipment issued by the association or
league to our child in the same condition as when received, except for normal wear and tear.
Email address *
Player's First Name *
Your answer
Your answer
Player's Date of Birth *
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/
DD
/
YYYY
Street Address, City, State, Zip *
Your answer
Home Telephone *
Your answer
Cell Phone *
Your answer
Last Year's Association / Team *
Your answer
Elementary School Boundary *
Your answer
League Age - (as of August 31, 2019) *
Your answer
Is this candidate on a roster for any other team (AAU, USSSA, High School, Little League, or any other league)? If Yes, Team *
Your answer
IS THIS CANDIDATE COVERED BY HEALTH INSURANCE? *
By typing your name below signifies you agree that all the above information is true and accurate and are completing this form using an electronic signature. *
Your answer
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