Early Registration: 7/14-8/4

Regular Registration: 8/5-8/25
Late Registration: 8/26-9/1
No Registrations After 9/1

MYSA Fall 2018 Registration Form
Player Name: _________________________________________________________________DOB: ______________
Parent/Guardian Name(s): ____________________________________________Phone:_________________________
Address: __________________________________________________________E-mail:________________________

Volunteer Information
______Coach ______Concession Stand ______Umpire
______Team Sponsor($300 Per Team) ______Field Preparation ______Referee
Volunteer Name:__________________________________________________Phone:__________________________
Please check one sport/division based on MYSA League Age:
Baseball (Age by 4/30/18) Fee Softball (Age by 12/31/17) Fee Soccer (Age by 8/30/18) Fee
_____T-Ball (4-6 yrs) $65 _____12U (11-12 yrs) $90 _____U6 (4-5 yrs) $70
_____Rookie (7-8 yrs) $85 _____14U (13-14 yrs) $90 _____U8 (6-7 yrs) $70
_____Minor (9-10 yrs) $90 _____16U (15-16 yrs) $100 _____U10 (8-9yrs) $70
_____Major (11-12 yrs) $100 _____U12 (10-11 yrs) $70
_____Senior (13-15 yrs) $100
*Registration Fees include Team jersey and cap/visor for Baseball/Softball and Team jersey, socks, shorts for soccer.
*Payment must be attached to form. No team placement until payment is made. Late Sign-up Fee $15. No Refunds.
Please select jersey size:
_______YS _____YM _____YL _____AS _____AM _____AL _____AXL
Please Read and Initial Below:
I, the parent/guarding of the above-named player, hereby give my approval for participation in any and all MYSA Babe Ruth
activities. I know that participation in Baseball/Softball/T-Ball/Soccer may result in serious injuries. I do hereby waive, release, and
agree to hold harmless Putnam County School District, or the Melrose Youth Sports Association, MYSA Board of Directors and
representatives thereof for any cause except in amount covered by accident or liability insurance ($350.00 deductible- K&K
Insurance).
I agree to release and hold harmless the individual coaches, players, and other staff while acting in their capacities as such, from any
and all claims of liability which may arise in any manner or form from my child’s participation in this clinic. As a parent of the above
player, I take full responsibility for payment of injuries that may occur during the MYSA Softball clinic and I hereby waive and
release said persons from any liability of injury incurred while attending the clinic.

______I agree to support all MYSA rules concerning spectator decorum. I understand that in the event of poor
sportsmanship, I may be ejected from the field.
______I WILL NOT SMOKE on MYSA or Melrose School and Park grounds
______I WILL NOT BRING ANIMALS/PETS onto MYSA or Melrose School and park grounds.
______I give permission for photographs and/or videos of my child to be displayed on the MYSA website and Facebook.

Parent/Guardian Signature: ________________________________________________ Date: ___________________
Payment Method: _____Cash _____Check ($35 Returned Check Fee) _____Credit Card
Date Paid______________ Received By__________________________
Make checks payable to MYSA. Mail registration and fee to P.O. Box 1491, Melrose, FL 32666