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Recreation Association
P.O. Box 621, Roanoke, IL 61561


First Name: _________________________
Current Grade in School: _______
Circle Shirt Size:

Youth: (6-8)

Last Name: __________________________

Birth Date: ____ / ____ / ____


(14-16) Adult:(Small)

Age on April 30th: ______




Please mark the league that you want your child to participate in:


Childs age on 4/30




4, 5, or 6 yrs old




6, 7, or 8, yrs old




8, 9, & 10 yrs old

Description of League & Commitment

Players hit from a tee or coach pitches under hand.
Practices & Games are Saturday mornings.
Players hit from a pitching machine & play with rules and outs.
Practices & games are various nights and Sat afternoons
Players pitch & play with rules and outs. Practices will be held
First half of season and games second half.
Practices & games are various nights and on Saturdays.

Please pay cash or check payable to RBRA Registration time is March 4th from 6-8pm AND
March 5th from 11-1pm in High School gym or mail to: PO Box 621, Roanoke, IL 6156

( A late fee of $10 will be added after March 15th)) REGISTRATION CLOSED AFTER
March 24th
Volunteers are needed to make this program a success for the kids, please get involved!
Name of Coach: ______________________ Ph#: _________________ (Please mark the level of commitment you are willing
to make!)

Head Coach
Asst Coach

- Attend almost all of the practices/games and serve as a contact for the team.
- Attend most of the practices/games and fill in when head coach is not available.

This registration form and the fee are required prior to participation and serves as a permission slip for each player to
participate in the RBRA baseball program. All participants are responsible for their own health insurance coverage. In case of
an emergency, I give permission for my child to be given any necessary medical attention by a qualified and licensed medical

Parent / Guardian Names: ______________________________

Date: __________________

Email Address: ____________________________ Cell: _________________

Emergency Contact Name: ____________________________

Phone: __________________

Board of Directors
Chad Martin, Jonathan Weber, Jesse Martin, Dawn Alford, Norm Weldon, Vince Hummel,
Leslie Cargill, Dirk Norman, Brian Riefsteck