10U DPYB Part Time Travel Team Payment Portal

PLAYER INFORMATION

PARENT/GUARDIAN #1
PARENT/GUARDIAN #2

MEDICAL/EMERGENCY CONTACT INFORMATION

WAIVER INFORMATION
Parental Authorization - Medical Release For Participation In Des Plaines Youth Baseball
I, the undersigned, parent/guardian of the player named above for and in consideration of that player
being permitted to participate in the activities of the Des Plaines Youth Baseball, do hereby agree to release,
absolve, indemnify, and hold harmless Des Plaines Youth Baseball, its officers, directors and supervisors,
volunteers, coaches, participants, and all persons providing transportation to and from its activities, of and
from any and all claims, actions or causes of action of any nature arising out of or in the course of, such
participation including, but not limited to, practice sessions, games, contests, and transportation to or from
such. As parent/guardian I do herewith grant permission to the adult manager, coach, and business manager of
the team or organization to obtain medical care from any licensed physician, hospital, or medical clinic, for
the player named herein at such time as either parent or legal guardian cannot be contacted in person or by
telephone.
I further agree to abide by the terms of the following Parent’s Code of Ethics:
I hereby pledge to provide positive support, care and encouragement for my child participating in Des
Plaines Youth Baseball, I will encourage good sportsmanship by demonstrating positive support for all players,
coaches, and officials at every game, practice or other Des Plaines Youth Baseball, event. I will place the
emotional and physical well being of my child ahead of personal desire to win.
I will support coaches and officials working with my child in order to encourage a positive and enjoyable experience
for all. I will obey
posted rules on both public and private properties during the course of activities. I will encourage my child to
treat other players, coaches, fans and officials with respect. I understand Des Plaines Youth Baseball is enforcing a
zero tolerance policy regarding any player, parent, spectator, or coach who violates the Rules of Conduct. I
have read and agree to abide by the Rules of Conduct of Des Plaines Youth Baseball; as such rules may be
amended from time to time. (www.desplainesyouthbaseball.org)
Signature:
Date:
 

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Payments Accepted By

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Chico's
American Legion DP Post 36
Gerber Collision And Glass
American WildBurger
Feldco Windows
Twisted Tree Yoga Studio
Corporate Coach
Belmont-Kolmar Towing
Wally's Car Star
MACKDANIEL INSURANCE COMPANY
Michael G Durbin Orthodontist
TD Construction Service
River Trails Orthodontics
Signarama
Dr. Fijal
Collision Damage Experts
MAURO SEWER CONSTRUCTION
IAMAW Local 1487
Oakton Community College
Brad Stephens for Mayor
Why Not Complete Home Improvement
Vision Care Specialists
J B MetalWorks
Optimist Club of Des Plaines
Marty Moylan
Barnaby's Pizza
The Bridge Community Church
Ching Hua's
Kumon
PRiSMS
Oakton 2
Home Comfort Heating & Cooling
Bishop Plumbing
3D Brick Paving