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2012 Player Registration Form by HC12092017941


									                                2012 Player Registration Form

Eligibility: Those youths who reach their 5th birthday by April 30, 2012 and will not reach their
                                18th birthday by May 1, 2012.

           Please mark age group of participant (calculated as of April 30, 2012)
                      5 and 6     $40.00                      11 and 12   $45.00
                      7 and 8     $45.00                      13 and 14   $45.00
                     9 and 10     $45.00                      15 to 17    $50.00

Player Name: ___________________________________________________
Date of Birth: Month ___________ Day ___________ Year ___________
Address: ____________________________________________________
City: ________________________ State: _____________ Zip: ________________
Home Phone: _________________ Emergency Number: _____________________
Please circle a shirt size. Youth: S M     L Adult: S     M    L XL 2XL

Please check here if player is interested in umpiring (must be 11 or older) _____

We are proud to be supported by the Greater Marietta United Way. The United Way has
generously funded a limited number of half priced registration grants. You will be asked to
complete an income verification form to receive half price registration. If you believe that you
fall into the income base to qualify, please come to one of the two registration times to complete
the appropriate paper work. You will be asked to pay ½ of the registration fee the night of
registration. To help raise public awareness you may be contacted by the United Way to discuss
the impact of their donation.

Volunteers: The MBBL is always in need of volunteers to make our programs successful. Please
indicate below if you would like to volunteer your time to our programs in the following
Coach ____ Assistant Coach ____Umpire ____ Board Member ____ Fair Worker ____
Please Print your name and phone number so we may contact you.
Name: ___________________________________
Phone: ________________________
For Administrative Use Only:
Amount Received __________ Date __________ Check # __________ Initials ________
                                                                                  Over Please 
Special requests or needs: Please indicate any special request or needs of the child. Also
indicate any times or dates when your child will be unable to participate. (e.g. health constraints,
medical conditions, church, competitive soccer, AAU basketball, etc.) We cannot guarantee all
requests will be honored, other than siblings in the same age group being on the same team.

Medical Release/Authorization: This is to certify that I, as the parent or guardian of

________________________________ a player in the Marietta Bantam Baseball League
   (Please Print Player’s Full Name)

hereby grant permission to the adult manager, coach, trainer or business manager of the team to
obtain medical care, at my expense, 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. This authorization shall include all league activities, including the period
required to travel to and from those activities if need be. We do hereby waive, release, absolve,
indemnify, and agree to hold harmless Marietta Bantam Baseball League; the organizers,
supervisors, participants, and persons transporting the player to and from those activities, for any
and all claims arising out of injury to the player.

Furthermore, as the legal guardian, I will act in a positive and supportive role for agents of the
Marietta Bantam Baseball League. I will show respect and sportsmanship to all players, coaches,
and fellow parents and/or guardians during the season.

_________________________________               __________________________________
Signature of Legal Guardian                      Please Print Full Name

Mail form and check to MBBL, PO Box 536, Marietta, OH 45750 or drop off at the MBBL
concession stand between 5 and 7 PM Friday March 2nd or Friday March 9th.

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