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					               2008 Youngstown/Fountain Baseball Association, Inc
         DIZZY DEAN BASEBALL/SOFTBALL PLAYER REGISTRATION

(Please Print)
PLAYERS FULL NAME: (Last) ___________________(First)___________________Middle Init.______

AGE as on May 1, 2007: _____ SEX Male______Female______

DOB______________________ BC # ______________________and State

Medical Restrictions Medicines or Allergies No_____ Yes_______List Medical Restrictions, Medicines or
Allergies:______________________________________________________________________________
______________________________________________________________________________________

 Mothers Name:                                          Fathers Name:
 Address                                                Address
 City/St/Zip                                            City/St/Zip
 Phone (Hm)                                             Phone (Hm)
 Phone (Wk/Cell)                                        Phone (Wk/Cell)

 Guardians Name:                                        GuardiansName:
 Address                                                Address
 City/St/Zip                                            City/St/Zip
 Phone (Hm)                                             Phone (Hm)
 Phone (Wk/Cell)                                        Phone (Wk/Cell)

PARENTAL/GUARDIAN AUTHORIZATION
I, parent or guardian of the above named candidate for a position in above mentioned baseball program,
hereby gives approval to his/her participation in any and all Youngstown/Fountain Baseball Association,
Inc activities during the current season. I assume all risks and hazards incidental to such participation
including transportation to and from the activities; and do hereby waive, release, absolve, indemnify and
agree to hold harmless the parent or local Youngstown/Fountain Baseball Association, Inc organization,
the organizers, sponsors, supervisors, participants and persons transporting the player to and from activities,
for any claim arising out of an injury to the player, except to the extent and in the amount covered by
accident and/or liability insurance held by the local Youngstown/Fountain Baseball Association, Inc.
I also grant permission to managing personnel or other Youngstown/Fountain Baseball Association, Inc
representatives to authorize and obtain medical care from any licensed physician, hospital or medical clinic
should the player become ill or injured while participating in Youngstown/Fountain Baseball Association,
Inc activities away from home, or at other times when neither parent, nor guardian is available to grant
authorization for emergency treatment.
I agree to return upon request the uniform and other equipment issued to the player in as good a condition
as when received, except for normal wear and tear.
I will furnish a certified birth certificate of the above named candidate upon request by
Youngstown/Fountain Baseball Association, Inc officials.
I understand that if I, my child, my spouse or any person or persons accompanying me to any
Youngstown/Fountain Baseball Association, Inc event, show BAD CONDUCT or POOR
SPORTSMANSHIP toward anyone, the Youngstown/Fountain Baseball Association, Inc will have
authority to dismiss myself or individual showing this conduct, or my child from the team or any activities
in which they participate for a period deemed appropriate by the Youngstown/Fountain Baseball
Association, Inc.

NAME OF PARENT OR
GUARDIAN:___________________________________RELATIONSHIP:________________________

SIGNATURE:____________________________________________DATE:_______________________



7/7/2010
               2008 Youngstown/Fountain Baseball Association, Inc
         DIZZY DEAN BASEBALL/SOFTBALL PLAYER REGISTRATION

                                      Other Important Information

Team your child played for last season_________________________________________

Coach your child played for last season_________________________________________

Please provide the following uniform size information:

 Pants Youth Sizes __S__M__L__XL__XXL__               Pants Adult Sizes __ S__M__L__XL__XXL
 Shirt Youth Sizes __S__M__L__XL__XXL                 Shirt Adult Sizes __S__M__L__XL__XXL

Please provide the following volunteer information Check One or More:
   Concession Stand Helper                       Scorekeeper
   Head Coach                                    Assistance Coach
   Team Mom                                      Sell Raffle Tickets
   Fun Day Booth or Event Worker                      Assist Player Agent
   Assist Equipment Manager                           Assist Fund Raising Events
   Assist in getting Team Sponsors                    Assist with working on Facilities
   Play Adult Co-Ed Softball                          Would you like to purchase a Team
                                                      T-Shirt for $12.00
                                                      Adult shirt sizes
                                                      __S__M__L__XL__XXL
   Other:
Note: Any adult volunteer working for the Youngstown/Fountain Baseball Association, Inc. must
agree to a background check at the Bay County Sheriff Department.

If you have managed or coached before, please provide details and number of years experience:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Would you like to participate in the TEAM BOOSTER T-Shirt Fund raiser? ______Yes ______No
You get people to sign up to support your child by donating $25.00 to have their name printed on the
back of the booster T-Shirt. When you collect 6 Boosters and turn in the money to the league your
child’s registration fee will be refunded. Your child receives the booster shirt to wear. What size shirt
would you like? YS YM YL YXL AS AM AL AXL AXXL

Parent/Guardian e-mail address________________________________________________________


Do you know any child unable to play due to lack of equipment, funds, transportation, etc.?

Name____________________________Address_________________________
Phone #____________________________




7/7/2010
             2008 Youngstown/Fountain Baseball Association, Inc
       DIZZY DEAN BASEBALL/SOFTBALL PLAYER REGISTRATION

Bay County Sherriff’s Office
Frank McKeithen, Sheriff
3421 N. Highway 77
Panama City, Fl 32405
(850) 747-4700


                     Local Law Enforcement Records Check Form

Name:________________________________________________________________
      Last                          First             Middle

Maiden name and/or past married names:____________________________________
_____________________________________________________________________

Sex/Race________/________            Date of Birth:____________________________

Social Security #:_____________________Drivers License #____________________

                                 Release of Information

I, _________________________________, hereby give the Bay County Sheriff’s Office
               (Print)
Permission to search their local law enforcement files and release any information found
to President, Youngstown/Fountain Baseball Association, Inc., Mr. James M. Fath.

       Date:_______________Signed:________________________________

       Notary/Witness:________________________ Comm: Expires_____________
       (Not required on self if brought in by self & with proper ID)

                       Findings of Local Law Enforcement Check

Record Found ( )No ( ) Yes
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

              Date Checked________________ Checked By____________________
              (Current from 6-86 to Date) Call the jail for any possible arrest
              information after date checked.)




7/7/2010

				
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