2019 Defiance Baseball Registration
Email address *
Player's First Name *
Your answer
Player's Last Name *
Your answer
Select the age level your child would like to play: *
Required
Player Size *
Requested Player Number (Need 3 options)
Your answer
Player's Birthdate *
MM
/
DD
/
YYYY
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Parent/Guardian Address *
Your answer
Parent/Guardian City *
Your answer
Parent/Guardian State *
Your answer
Parent/Guardian Zip *
Your answer
Parent/Guardian Cell Number *
Your answer
I am interested in:
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Hospital Preference
Your answer
Physician Phone
Your answer
Family Dentist
Your answer
Family Dentist Number
Your answer
Allergies *
Medical Conditions *
I/We, the parents and/or guardian of the named candidate on this form for a position on a team, hereby give my/our approval to participate in any and all program activities. I/We assume all risk and hazards incidental to such participation, including transportation to and from the activities. I/We hereby waive, release, absolve, indemnify and agree to hold harmless the Defiance Baseball Association, the chartering organization, the organizers, sponsors, coaches, participants and persons transporting my/our child to and from activities for any claim arising out of an injury to my/our child, whether the result of negligence or from any other cause, except to the extent and in the amount covered by accident and liability insurance. *
Required
I/We, understand that the $75 player fee is due no later than March 31, 2019 after which will be $100. (8U will be $40 before and $60 after.) *
Required
I/We, understand that the remaining balance is non refundable and due no later than May 1st, 2019. This amount will be determined once schedules are created. *
Required
If you wish to look into financial assistance, please select yes.
Comments or questions? (Email: defiancebaseball247@gmail.com)
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Please type name as a signature for the form above: *
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