NJJBA - 2008 Fall Ball Registration

Player Information (all fields are required)

Last Name:	First Name:	Middle:
Address:	City:	Zip Code:
Phone:	Email:

Parent/Guardian Information (if any info is same as above, please put 'Same' or leave blank)

Name 1:		Relationship:
Alt. Phone:		Email:

Name 2:		Relationship:
Alt. Phone:		Email:

Eligibility Information (* indicates required field)

DOB *:		League Age (as of May 1, 2009)*:
School *:		Other? Please Provide *:
High School Area *:	(Can be defined via residence address or attending Elementary/Middle School)
WHAT TEAM DID YOU PLAY FOR IN THE SPRING 2008 SEASON?
Spring 2008 Team:		Spring 2008 Coach:
Spring 2008 Age Group:		Spring 2008 Level of Play:
Spring 2008 High School Area:		Birth Certificate on file with NJJBA?	YES NO (If No, a copy of State Certificate of Live Birth MUST be provided)

League Information/Player Options

League Registering for:
Special Requests (Coach/Team/Player) (free form text area; 150 characters max):

Refund requests must be in writing and are subject to a $50 handling fee. No refund will be given after the first league game, or if the league jersey has not been returned.

Shirt Size Selection

YOUTH:

ADULT:

Additional Comments

Emergency Contact Information

Name:		Phone:
Address:
Known medical conditions, including allergies:
Hospital Preference:
Family Physician Name:		Family Physician Phone:
Family Dentist Name:		Family Dentist Phone:

Release and Authorization

I/We the parent(s) or guardian(s) of the above named candidate for a position on a North Jefferson Junior Baseball Association (NJJBA) team, hereby give my/our approval to participate in any and all league activities. I/We understand that it is our responsibility to notify league officials of any change in medical conditions or concerns.

I/We know that participation in baseball may result in serious injury or death and protective equipment does not prevent all injuries to players and do hereby waive, release, absolve, indemnify and agree to hold harmless the NJJBA, Jefferson County Junior Baseball League, North Jeffco Parks and Recreation, City of Arvada, City of Westminster, Jefferson County School District, the organizers, sponsors, participants and persons transporting my/our child to and from activities for any claim arising out of injury to my/our child whether the result of negligence or for any other cause, except to the extent and in the amount covered by accident or liability insurance.

I/We also grant permission to managing personnel to authorize and obtain medical and/or dental care or treatment from any licensed physician, hospital or medical clinic should my child become ill or injured while participating in any Association or League activities when neither parent nor guardian is available to authorize emergency treatment.

By signing below, you hereby agree to the "Release and Authorization"

Parent/Guardian Signature:

Date: