BSM YOUTH ASSOCIATION PLAYER SIGNUP

 

              CIRCLE ONE:      BASKETBALL     BASEBALL     SOFTBALL     SOCCER

 

 

Were you on a BSM team last year? ___ Yes ___ No                  Current

If no, how many years experience does player have? ________                Age _______

 

Name ____________________________________  Date of Birth _________________

 

Address _______________________________________________________________

 

City ________________________________ State ____ Zip _____________________

 

Email address: _________________________________________________________

 

Parent/Guardian names __________________________________________________

 

           # 1  Home Phone _____________ Work ______________ Cell Phone _____________

 

           # 2  Home Phone _____________ Work ______________ Cell Phone _____________

 

Individual to contact if parent/guardian cannot be reached:

 

________________________________________ Phone (_______) _______________

 

CIRCLE ONE SHIRT SIZE AND ONE HAT SIZE

 

 

     Shirt size:    Adult XL     Adult L     Adult M     Adult S     Youth L     Youth M     Youth S

 

       Hat size:                     Adult M – XL          Adult S – M          Youth M – XL 

                                           

                                              (Coach Pitch & Tee Ball will automatically receive a Youth adjustable hat)

 

Pant/Short Size: Adult XL    Adult L    Adult M    Adult S    Youth L    Youth M    Youth S  

            -----------------------------------------------------------------------------------------------------------------

 

Parent interested in being a  ____ Coach     _____ Assistant Coach      ____  Neither

 

Name of Parent/Guardian interested in coaching: ______________________________

 

                                  WAIVER AND EMERGENCY MEDICAL TREATMENT

         

           I hereby certify that my child is in normal health and capable of safe participation in BSM

Youth Association programs.  I assume all risks and hazards incidental to the conduct

of this program and for the transportation to and from the program.  In the event that

I cannot be reached to make arrangements for emergency medical attention at the time

of an illness or accident, I hereby authorize the  transportation of my child to the nearest

medical facility for treatment deemed necessary.  I hereby, for myself, my heirs, executors

and administrator, waive and release any and all rights and claims I may have against

the BSM Youth Association and their respective representative(s) for any and all

injuries, damages or losses which maybe suffered in connection with any participation

in this program.

 

___________________________   ____________________________   ____________

                        Player’s Signature                          Parent/Guardian Signature                    Date

 

          If the Baseball Director asked you to mail this:  2312 River Run Road, Brown Summit, NC 27214