2013 KENTLAND SOFTBALL

(CIRCLE ONE AGE GROUP)

9 - 10

11 - 12

13 - 14

Name:________________________________________________________________
Age as of 5-1-2013 __________

Birth Date: ________________________

Certificate Provided:

Yes

No

Parents: ______________________________________________________________
Telephone #('s) _______________________________________________________
Emergency Contact: __________________________ Phone: _______________
Doctor: _______________________________________ Phone: _____________
E-Mail: _____________________________________________________
Please circle as many of the following you are interested in:
Coach

Asst. Coach

Umpire

Board Member

Other _________

Shirt Size - (circle one)

Youth:
Adult:

Small
Small

Medium
Medium

Large
Large

X-Large
X-Large

Medium
Medium

Large
Large

X-Large
X-Large

Short Size - (circle one)

Youth:
Adult:

Small
Small

Medical Release: Kentland Baseball / Softball Association will carry insurance on every player for
Basseball/softball related accidents which may occur during the regular season (practice & games). This
insurance is in the form of a secondary policy. You are the responsible party for any .medical treatment
deemed necessary for your child at the time of an injury during any routine baseball / softball activity.
Included in your registration fee for you child/children is a $1.00 membership fee to Kentland Baseball /
Softball Association. Placement of all players will be left to the Boards discretion

Parent / Guardian Signature: ___________________________________