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Baseball & Softball Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

Email:

* Gender:

Grade:

* Select the appropriate division::

* Select Shirt Size:

PRIMARY PARENT/GUARDIAN INFORMATION

* Firstname:

* Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

ADDITIONAL PARENT/GUARDIAN INFORMATION

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

Registration fee is $60 and is due to the CYSA Board prior to the first practice.

CYSA was created by the caring members of the Campbell community and continues in its mission only through the support of volunteers and parents. To help minimize registration fees, we ask each parent/guardian of the participants to donate some of their time towards supporting these sporting activities.

* Please select below an option as to how you may able to support the CYSA::

If OTHER, please add comment here::

WAIVER INFORMATION

I, parent/legal guardian of the above listed registrant, give permission to participate in the Campbell Youth Sports Association (CYSA), and state that I will not hold CYSA responsible for any injury incurred during baseball participation.

Accept this agreement *

Decline

* indicates required fields

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Baseball & Softball Registration Form