Barrington Youth Association

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Babe Ruth All Star Registration

If you have been chosen as an All Star, please use this form to register and pay online.

* Age:

* Player’s Name:

* Parent/Guardian Name:

* Legal Address:

* Town:

* Email Address:

* Birth Date:

Phone:

Regular Season Team:

* Is your child covered by any health insurance?:

Yes

The Parent/Guardian of the above named applicant consents to participation by the applicant in this year’s Barrington Youth Association (BYA) baseball/softball program and hereby assumes all responsibility for ordinary hazards and risks arising out of or incidental to the activities of said program. Signer agrees to hold harmless the Town of Barrington and its participants in the BYA to all claims for any injury.

Payments to BYA are non-refundable as we have to order uniforms and space on teams is limited. In extreme cases of injury, BYA may elect to refund registration fees on a case by case basis.

I agree to the terms above. *

MEDICAL RELEASE FOR BARRINGTON YOUTH ASSOCIATION

I, the undersigned, state that I am the parent, legal guardian or custodian of the minor indicated above.

For this minor, I hereby authorize the coach of my son/daughter to see that emergency medical care is given at the hospital most convenient to the accident. The hospital may administer such emergency treatment as may be necessary for the preservation and health of the child. It is my intent by this consent to include the administration of drugs, anesthetics and applications of any medication which circumstances may require on an emergency basis.

I agree to the terms above. *

Additional Medical Comments:

Permission for Photographs/Video of Players.

This permission is for your child to be photographed and/or video taped while participating in BYA activities for use on the website or other media articles(players will not be identified by name).

* Permission for Photographs/Video of Players:

I give permission for my child to be photographed and/or video taped

I DO NOT give permission for my child to be photographed and/or video taped.

Signature:

Date:

* indicates required fields

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Babe Ruth All Star Registration