2016 Fall Ball Registration

Divisions and Birth Year

It is recommended that you play in the division you are eligible for in 2017, as follows:

12U Minors 2003-2005
10U Farm 2006-2007
8U Rookie 2008-2009

Tryouts

Tryouts will be held on Sunday July 24th at 11am and Tuesday August 2nd at 6pm at McDougal Field. Girls interested in playing Fall Ball need to only attend one tryout. TRYING OUT DOES NOT GUARANTEE PLACEMENT ON A TEAM.

Player Information

Player 1

First Name *

Last Name *

Date of Birth (mm/dd/yy): *

Division: (Recommendation: Born 2004-2005 for 12U; Born 2006-2007 for 10U, Born 2008-2009 for 8U) *

Rookie (8 & Under)

Farm (10 & Under)

Minors (12 & Under)

School

Enter school name (if not on list)

How many years experience does your daughter have playing softball? *

Is your daughter: *

Not planning on pitching

A new pitcher

A new pitcher, taking lessons

An experienced pitcher (Has Pitched consistently for two seasons)

Is your daughter: *

Not planning on catching

A new catcher

An experienced catcher (Has caught consistently for two seasons)

Player 2 (or skip to "Family Information" section below)

First Name

Last Name

Date of Birth (mm/dd/yy)

Division: (Recommendation: Born 2004-2005, 12U; Born 2006-2007, 10U, Born 2008-2009)

Rookie (8 & Under)

Farm (10 & Under)

Minors (12 & Under)

School

Enter school name (if not on list)

How many years experience does your daughter have playing softball?

Is your daughter:

Not planning on pitching

A new pitcher

A new pitcher, taking lessons

An experienced pitcher (Has pitched consistently for two seasons)

Is your daughter:

Not planning on catching

A new catcher

An experienced catcher (Has caught consistently for two seasons)

Family Information

PARENT/GUARDIAN INFORMATION

First Name *

Last Name *

Address *

City *

Zip *

Cell Phone (xxx-xxx-xxxx) *

Alternate Phone (xxx-xxx-xxxx)

Email Address *

Please email me updates (This is used for league info only and will not be used for solicitations)

Residency: *

Resident of Belmont or Redwood Shores

Non-Resident

OTHER PARENT/GUARDIAN INFORMATION

First Name

Last Name

Address

City

Zip

Cell Phone (xxx-xxx-xxxx)

Alternate Phone (xxx-xxx-xxxx)

Email Address

Please email me updates (This is used for league info only and will not be used for solicitations)

Emergency Contact

First Name *

Last Name *

Cell Phone (xxx-xxx-xxxx) *

Alternate Phone (xxx-xxx-xxxx)

Medical/Dental Information

Medical Insurance Carrier *

Child's Doctor's Name/Phone Number: *

Enter Doctor's Name (if not on list) *

Doctor's Phone Number *

Child's Dentist's Name/Phone Number: *

Enter Dentist's Name (if not on list) *

Dentist's Phone Number *

Additional Medical Notes:

Required Consents

By checking this box, I (WE) the above-named parent or legal guardian of the participant hereby authorize the Manager, Coaches or Parents of the team members acting in the capacity of activity supervisor/vehicle drivers, as my agents to consent to medical, surgical or dental examination and/or treatment. In case of emergency, I hereby authorize treatment and/or care at any hospital. If there is an emergency and I cannot be reached, please contact the following emergency contact who is hereby authorized to act on my behalf.

*

I Grant Emergency Action Authorization

By checking this box, I (WE) do hereby give my consent for the player(s) registered on this form to participate in the Belmont-Redwood Shores Youth Softball Association program during the current season and assume all risks and hazards which are incidental to the conduct of the activities. I (WE) further agree to release, absolve, indemnify and hold harmless this local Belmont Redwood Shores Youth Softball Association, its officers, its directors, their sponsors, organizers and supervisors of any and all legal responsibilities. I (WE) do further agree that the above named registered player will participate according to the rules of the Belmont Redwood Shores Youth Softball Association.

*

I Grant Participation Consent

By checking this box, I (WE) do hereby grant permission to the Belmont/Redwood Shores Youth Softball Association ("BRSYSA") to use photographic and video images of my child, captured during regular and special BRSYSA activities through video, photo and digital camera to be used solely for the purpose of display on the BRSYSA website or the official "2015 BRSYSA Season" DVD. I also understand that once the images are posted on the website, the images can be downloaded by any individual who has access to the website. Therefore, I agree to indemnify and hold harmless from any claims (1) BRSYSA; (2) all volunteer members of the Belmont/Redwood Shores Youth Softball Association, and (3) the City of Belmont. BRSYSA reserves the right to discontinue use of all materials without notice.

*

I Grant Image Use Permission