Pierce Youth Boys

T-Ball/Coach Pitch Registration

Children Currently in Grades Pre-K & K
Registration Deadline May 21, 2014
Name _______________________________________________Age __________ Grade all !"#$ ____________
T-%&'RT %'() )*tra %mall $ - + %mall , - . /edium #" - #!
Parent0s Name _________________________________________ Phone 1&2 _______________________________
Parent0s Name _________________________________________ Phone 1&2 _______________________________
/other 1C2 ________________________ 132 _________________________
ather 1C2 _________________________ 132 _________________________
Address ______________________________________________________________________________________
)mail ________________________________________________________________________________________
4octor Name5 Address5 Phone num6er ______________________________________________________________
Please Note Any /edical Conditions _______________________________________________________________
)mergency Contact Name & Phone ________________________________________________________________

Practice times and locations 7ill 6e determined 6y the coaches8
Partici9ants are e*9ected to 9ro:ide their o7n 6all glo:e and ca9
The registration fee- $25 for 1
st
Child
$10 for Each dditional Child

Ma!e Chec!s "aya#le to $cott #ler
;uestions may 6e directed to %cott or %heila A6ler $"!-<<!-=><#5 $"!-,$<-!,,+5 sheilascott?9tcnet8net
or Clerical @se Anly
4ate____________ T-%hirt %iBe
CC D__________________
4ear Parents
There 7ill 6e a Tee-Ball/Coach Pitch Base6all Registration/ArganiBational /eeting5 /ay !#5 at =E"" in the
Pierce ire &all /eeting Room8 This meeting is For all 9arents 7ith 6oys that 7ill 6e entering %indergarten
or 1
st
grade in &all 2014, 7ho 7ish to 9lay Tee Ball/Coach Pitch Base6all8 This 7ill 6e an inFormation night as
7ell as an o99ortunity to 9ro:ide Feed6acC8
Please maCe sure to Fill out the email 9ortion oF the registration as most communications 7ill 6e made :ia email
or te*t8
"lease 'ote( 3e are getting ne7 t-shirts this season5 so e:eryone 7ill need to Fill out the t-shirt 9ortion8
Parental in:ol:ement is E'C)*R+ED and E,"ECTEDG
Please 6ring the com9leted registration and 7ai:er Form 7ith you to the meeting8
'F you ha:e Huestions 9lease contact %cott or %heila A6ler $"!-<<!-=><#5 $"!-,$<-!,,+5 sheilascott?9tcnet8net
3e looC For7ard to 7orCing 7ith you and your son8
IIII3e ha:e a ace6ooC Grou9-"ierce -outh T-#all....
"lease #e sure to /oin to !ee0 u0 to date 1ith any notices or schedule changes
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"2E$E RED CRE&*22- 'D $3+'(
________________________ has my 9ermission to 9artici9ate in the Pierce Boys T Ball/ Coach Pitch Program8 ' certiFy
that my child is Fully ca9a6le oF 9artici9ating in the designated s9ort and that my child is healthy and has no 9hysical or
mental disa6ilities or inFirmities that 7ould restrict Full 9artici9ation in these acti:ities8
' understand that there are certain risCs oF inJury inherent in the 9ractice and 9lay oF this s9ort5 as 7ell as in tra:eling and
other related acti:ities incidental to my child0s 9artici9ation5 and ' am 7illing to assume these risCs on 6ehalF oF my child8
'n the e:ent oF an inJury to my child5 ' here6y gi:e the Pierce Boys T Ball/ Coach Pitch Coaches 9ermission to arrange
trans9ortation For my child to a medical Facility5 and/or 9ro:ide my child 7ith emergency treatment or First aid8 '
understand that the Pierce Boys T Ball/ Coach Pitch Coaches do not assume any res9onsi6ility to taCe any oF these
actions8 ' gi:e 9ermission For my child to 6e treated 6y a license 9hysician and For the said 9hysician to administer
7hate:er care is necessary5 including anesthesia For their saFety and care8
The child0s Family 7ill 6e res9onsi6le For all oF the associated medical e*9enses8 ' 7ai:e and release any right and claims
' may ha:e against the Pierce Boys T Ball/ Coach Pitch Coaches5 and all mem6ers oF the Pierce Boys T Ball/ Coach Pitch
9rogram For any and all damages 7hich may 6e suFFered 6y my child in connection 7ith his/her association 7ith the
9rogram8
' acce9t res9onsi6ility For returning any and all eHui9ment used 6y my child to the Pierce Boys T Ball/ Coach Pitch or
agree to re9lace it8
$3+'T*RE )& "RE'T 44444444444444444444444444444444444444 DTE 444444444444