Bullhead City Girls Fast Pitch

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DETERMINED PROGRAM AGE BASED UPON PLAYERS AGE AS OF JANUARY 1, 2020
*MUST BE 4 YEARS OF AGE BY JANUARY 1ST, 2020 TO BE ELIGIBLE TO PLAY

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

Email:

Grade:

Age Group Playing:

* School:

* Shirt Size:

PARENT/GUARDIAN #1

* Firstname:

* Previous years played:

* 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 #:

* Does your child have any restrictions? Yes/No If Yes, please explain.Any comments or requests please list as well.:

WAIVER INFORMATION

*** Insert your waiver information here ***

PARENT'S CONSENT TO PARTICIPATE IN A.S.A. SOFTBALL/AUTHORIZATION TO TREAT MINOR.
I(we) do hereby give my(our) consent for the player registered on this form to participate in the NSA softball program for the current season and assume all risks and hazards, which are incidental to the conduct of the activities. I(we) understand that all rostered players of the team are covered by Markel Accident medical insurance Policy ($250 deductible) and coverage extends for 52 weeks from the time of accident. I(we) understand that this is secondary insurance to my (our) own policy and that this policy is only in effect for properly sanctioned NSA League activities including games, practices and local fundraising events. The maximum registration fee of $70 per player is to help cover the initial operation costs of the league. Any late registrations must be approved by board.

* I AGREE TO BE RESPONSIBLE FOR THE RETURN OF THE FUNDRAISING MONEY OF $52 TO BULLHEAD CITY ASA OR CHOOSE TO OPT OUT AND PAY $30:

ALL FEES MUST BE PAID IN FULL PRIOR TO PLAYER BEING PLACED ON A TEAM.
It is understood that in case of an emergency, every effort will be made to contact me(us) at the number(s) listed on this form. I(we)the undersigned parent(s) are legal guardian(s) of the player registered on this form, a minor, do hereby authorize and consent to any x-ray, examination, anesthetic, medical or surgical diagnosis rendered under the General Medical Practice Act. It is understood that this authorization is given in advance of any needed medical treatment and is given to insure that treatment will be given if deemed necessary by an attending physician. This authorization is given pursuant to the provisions of the civil code in my home state. Consent remains in effect until December 2018.

I/we agree with the above *

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