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Registration

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

City:

* State:

Zip Code:

Home Phone:

* Childs Age as of 12/31/2016:

Birthdate:

Gender:

Grade:

* Please select the age group you would like to play in::

T-Ball (Ages 5-6)

Instructional (8U)

10 & Under (10U)

12 & Under (12U)

14 & Under (14U)

How many years have you played:

What team did you play for last year:

Jersey Number 1st Choice and 2nd Choice:

* Residence School District:

* School you attend:

* Open Enrolment:

Yes

* Jersey size:

Youth Small

Youth Medium

Youth Large

Youth X-Large

Adult Small

Adult Medium

Adult Large

Adult X-Large

Adult XX-Large

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

EMail:

* Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Insurance Carrier:

Policy #:

Total number of kids registering:

A fee of $25 will be collected at registration for managing the concession stand.
Those parents who choose to work in the concession stand will have their $25 refunded after working their 2 scheduled games in the concession stand. If you have more
than 1 daughter playing you must work 2 games for each daughter to receive the refund.

I agree to the $25 concession stand fee *

I hereby give my permission for my child to participate in any and all CSA league activities for the 2017 season. I
assume all responsibilities related to such participation including but not limited to, transportation to and from CSA
activities. I do hereby release, absolve, indemnify, and agree to hold harmless the Crestview Softball Association, its
organizers, sponsors, supervisors, participants, and person(s) transporting my child, except to the extent covered by
the accident and liability insurance carried by the league

I/we agree with the above *

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IMPORTANT: Online Payment with credit cards is not active for this form

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