ELDON BASEBALL SOFTBALL ASSOCIATION
Registration Form
Player’s Name: ________________________________Date of Birth: _____/____/_____
Street Address: _____________________________City/State/Zip: _________________
Phone Number: _____________________________Sex: ___Male ___Female
Mother’s Name: _________________________Father’s Name: ____________________
Email address: ___________________________________________________
Has your child played organized Baseball/Softball before? ___Yes ___No
How many years? (Please circle) 1 2 3 4 5 6+
Do you have more than one child playing Baseball/Softball? ___ Yes ___ No
If Yes: Name(s):_____________________________________Age(s):_______________
Does your child have any medical or physical limitations (allergies, hearing, sight,
etc.)____________________________________________________________________
Do you have insurance for your child(ren)? ____Yes ___ NO
If Yes, please provide a copy of insurance card.
_____________________________
Parent/Guardian Signature/Date
_____________________________
Parent/Guardian Signature/Date
______________________________
Parent/Guardian Signature/Date
______________________________
Parent/Guardian Signature/Date
League use only:
Pant size: _______ Shirt Size: _____ | Paid: ___ CASH ____Check (#______ )
Hat Size (Please circle) Youth Adult | Age on June 30, 2017 : ________
| League Official Initials: ______
I/We the parents of the above named candidate for a position on an Eldon League Team, hereby give my
approval to participate in any and all League activities, including transportation to and from the activities.
I/We know that participation in baseball or softball may result in serious injuries and protective equipment does
not prevent all injuries to players, and do herby waive, release, absolve, indemnify and agree to hold harmless
the Eldon Baseball and Softball Association, Inc., the organizers, sponsors, supervisors, participants, and persons
transporting my/our child(ren) to and from activities for any claim arising out of any injury to my/our child(ren)
whether the result of negligence or for any other cause, except to the extent and in the amount covered by
accident or liability insurance.
I/We agree to return upon request the uniform and other equipment issued to my/our child(ren) in as good a
condition as when received except normal wear and tear. If not returned I will be charged a replacement fee
accordingly. I/We will furnish a copy of birth certificate of the above named candidate to League Officials upon
registration/request.
Medical Release Form
Note: To be placed at each concession stand used by the EBSA.
Player:_______________________________ Date of Birth:_______________________
Age Division:__T-Ball Baseball Softball River League
Parent or Guardian Authorization:
In case of emergency, if family physician cannot be reached, I hereby authorize my child
to be treated by Certified Emergency Personnel. (i.e. EMT, First Responder, E.R.
Physician)
Family Physician:_____________________________Phone:_( )__________________
Address:________________________________________________________________
(street, city, zip)
Hospital Preference:_______________________________________________________
In case of Emergency Contact:
Name
Phone Number
Relationship to Player
Please list any allergies/medical problems, including those requiring maintenance
medications. (i.e. Diabetic, Asthma, Seizure Disorder).
Medical Diagnosis
Medication
Dosage
Frequency of Dosage
The purpose of the above listed information is to ensure that medical personnel have details of any
medical problem which may interfere with or alter treatment.
Date of last Tetanus Toxid Booster: _________________________________________________
__________________________/_____/2017
Authorized Parent/Guardian Signature/Date
Warning: Protective equipment cannot prevent all injuries a player might receive while participating
in Baseball/Softball. Eldon Baseball & Softball Association does not limit participation in its
activities on the basis of disability, race, color, creed, national origin, gender, sexual preference or
religious preference.