League Registration Form

League Registration Form
Name of Athlete

First NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Graduation Year
Name of School
Parent/Guardian

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Relation to Athlete

Emergency Contact Information
Name of Emergency Contact

First NameLast Name
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Relation to Athlete

Confirmation
Emergency Treatment Parental Consent
I give my express and full permission to have my child treated by any qualified medical personnel, in case of any circumstance that such attendance be so required to do the following:

To secure necessary emergency medical care for my child.
Name of Doctor

First NameLast Name
Medical Care Facility
DISCLAIMER: Your child’s safety is our number one priority, and every effort will be made to protect the health and welfare of your child while in our care. However, West County Youth Baseball (WCYB) is not liable in any way in the event of harm, injury or illness that may occur as a result of your child’s participation in WCYB activities. In the event your child is harmed, injured or taken ill as a result of his/her participation in WCYB activities, including transportation to and from activities, recourse for the payment of any resulting hospital, medical or related costs and expenses will first be had against any accident, medical or hospital insurance, or any available benefit plan of yours or your spouse. If a complaint is filed against WCYB, the complainant agrees to pay for WCYB's legal fees. I acknowledge that through my child’s participation at WCYB, my child’s likeness, through but not limited to photographs, testimonials, videos and the like may be used for promotional purposes. Additionally, I grant consent for WCYB to receive information pertaining to my child’s academic and behavioral performance as necessary for successful participation in the Club’s programs. I understand WCYB is a drop-in facility, not a licensed day care provider. I accept that it is my responsibility to instruct my child and inform the staff on if and when my child is permitted to leave the Club on his/her own. WCYB is not responsible or liable for any consequences should my child leave the facility or program without approval or consent.
Signature of Parent / Guardian

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Name

First NameLast Name

PLEASE NOTE

Your registration is not fully complete until you have made full payment. All payments must be made at the West County Salesian Youth Club. Forms of payment are cash and card.

Thank you
Should be Empty:

League Registration Form

Emergency Contact Information

Confirmation