Hazelwood Youth Baseball League Registration Form

Age level __________ (before May 1, 2010)

Instructional Divisions ($70.00 per individual or $725.00 per team)

Fee includes 12-game season, player hat/shirt, some team equipment and individual trophies

__ Tee Ball (age 5)

__ Pitching Machine (age 6)

__ Pitching Machine (age 7)

Atom 1 and up Divisions ($75.00 per individual or $750.00 per team)

Fee includes 12-game season, division all-star game, playoffs, one dozen baseballs (per team), trophies (1st/2nd)

__ Atom 1 (pitching machine-age 8)

__ Atom 2 (age 9)

__ Bantam 1 (age 10)

__ Bantam 2 (age 11)

__ Midget 1 (age 12)

__ Midget 2 (age 13)

Team Name ________________________ Manager’s Name ____________________

Player’s name ________________________ Birth date ___________________

Address ____________________________ City/St/Zip ___________________

Home phone _________________________ Other phone_________________

Parents/guardians______________________

The City of Hazelwood exercises a HOLD HARMLESS POLICY during all sponsored programs, events & use of facilities. This releases the City and its agents, representatives or employees from any and all claims which may arise out of any accident or injury caused by the negligence of the City or its agents, representatives or employees when participating in a program, event or use of facilities sponsored by the City. As a guest of a resident using the City of Hazelwood weight room facility at Civic Center East, I consent that No liability either express or implies, will be incurred by City, its agents, servants, and employees arising out of the use of the premises by permittee, its agents, servants, employees, assigns, successors, invitees and licensees, during the day and date specified above. Permittee agrees to indemnify and save harmless the City, its agents, servants, employees, from and against any and all liability for damages arising from injuries to persons or damage to property occasioned by any acts or omissions of (other party) its agents, servants or employees, including any and all expense, legal or otherwise, which may be incurred by City or its agents, servants or employees, in defense of any claim, action or suit, irrespective of any claim that an act, omission or negligence of the city or its agents, servants or employees contributed to such injury or damage.

____________________________________ _ Parent Signature Date