BNBA Baseball Registration 2009
First Name: Have you played for BNBA Before? Yes No
Last Name: Division
( see front)
Parents: Birthdate
M / F
Address: Town
Postal Code: Home
Phone:
Email Work
Phone:
Emergency Name
& Phone #
Alternate Emergency
Contact & Phone #
Do you have
any medical problems, medication, special physical conditions, allergies etc.
of which the coaching staff should be aware?
YES / NO
Please Detail
Special
Requests:
Would you
like to be notified of Select tryouts for House league players only? Y / N
Are you
interested in attending the Academy Baseball Camp? Y / N
Please
CIRCLE the following areas you would be willing to help with.
Volunteers Name
Coach Helper Registration
Assist Coach Fundraising Awards Day
The
parent/guardian gives consent for to
participate in the above activity and releases the B.N.B.A. ,
M.C.B.A. and or DEIL from any and all liability and all claims pertaining to
the players and Parent/Guardian’s claim arising from the players involvement in
the activities of the association.
I hereby
appoint a Member of the B.N.B.A. coaching staff as my attorney for the purpose
of obtaining and consenting to medical care or treatment RECOMMENDED BY MEDICAL
PERSONNEL for
While in the course of BNBA, MCBA and or DEIL league
activities. I understand that any
such medical costs will be our responsibility (parents and / or guardian’s). I
hereby covenant and agree to ratify and confirm the actions of my attorney and
save my attorney harmless.
If you wish
to limit this appointment and consent, please check here and provide details of Limitation. .
Signature of
Parent/Guardian (or player if 18) Date
Mail with cheque to BNBA
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Amount Paid: Date:
Year
/ Month / Day
Parent/Guardian:
First Last
Name of Player:
First Last
Players Date of Birth
Year / Month / Day