CRESTWOOD YOUTH BASEBALL ASSOCIATION
Player’s Name_____________________________________________________________________________
Age on June 1st___________ Date of Birth__________________________ Birth Certificate on File_________
Player’s Address____________________________________________________________________________
City and Zip Code_____________________________________Township______________________________
Parents/Guardians Name_____________________________________________________________________
Phone______________________Cell/Pager___________________Email_______________________________
Emergency Contact___________________________________________Phone_________________________
Family Doctor_______________________________Preferred Hospital_________________________________
Did you play with Crestwood/Shalersville last year? YES NO (Circle One)
If Yes, What Team and Coach?_______________________________________________________________________
Would you like to play for this Team/Coach this year? YES NO (Circle One)
IF YOU CHOOSE NO, THIS PLAYER WILL GO INTO THE DRAFT
Is there any injury or physical condition that the coach should be informed of to assist this player’s participation in baseball? YES NO (Circle One)
If yes, please explain: ______________________________________________________________________________
Would Parent/Guardian be able to manage or assist in managing the team? YES NO (Circle One)
Would Parent/Guardian be able to help the league in any other way? YES NO (Circle One) If Yes, Check Below:
Field Maintenance______ Transportation_______ Equipment Donation______ Volunteer for Events_____
I hereby release the Crestwood Youth Baseball Association, its agents, sponsors, officers, managers, coaches and umpires from any and all liability as a result of my child’s participation in Crestwood Youth Baseball. I do voluntarily assume the risk for my child’s participation in activities during the 2007 season.
Parent/Guardian Signature_____________________________________Date______________
FEES: Pee Wee, Coach Pitch and Classifications H, G, and F (ages 5 to 14)
$75 per player; $55 for second player in family; $175 maximum per family
Senior League (ages 15 to 18) $85 per player; $65 for second player in family; $185 maximum per family
TOTAL AMOUNT DUE:_____________________ CHECK #____________ CASH________________
Pant Size: Adult________ Youth________ Shirt Size: Adult_______ Youth_______
S_____M_____L_____XL_____ S_____M_____L_____XL_____
Additional Shirt for Parent(s): Qty: ____ x $10.00 = $_________ Size(s): S____M____L____XL____
Car Decal(s): Qty:______ x $20.00 = $_______ Style #1 or Style #2
May Raffle Ticket(s): Qty:______ x $5.00 = $________ (1)______ (2)______ (3)______
Reverse Raffle Ticket(s): Qty:_______ x $65.00(couple) $50.00(single) = $________