Northern Kentucky Youth Association - Amazon Web …nkya.com BASEBALL Registration Form Visit us...
Transcript of Northern Kentucky Youth Association - Amazon Web …nkya.com BASEBALL Registration Form Visit us...
Registration For: INSTRUCTIONAL BASEBALL
Sex (M/F)
State
Does the above participant have medical insurance? Yes NoDoes the above participant have any medical conditions that N.K.Y.A. needs to be aware of? Yes No
If yes above, please explain:
Has the participant played for this coach within the last twelve (12) months? Yes No
Would you be willing to volunteer any time or skills to assist the N.K.Y.A. Organization? Yes No
O Youth X-Small (4-6) O Youth Medium (10-12) O Adult SmallO Youth Small (6-8) O Youth Large (14-16) O Adult Medium
$1 of your Registration fee is applied to Membership Dues.
O Birth Certificate on File (returning to organization) O Birth Certificate checked (new player)
Cash
Player Requested
email address
For Registrar Use Only
* I have read the Northern Kentucky Youth Association Concussion Information Sheet and understand what a concussion is and how it may be caused. I also understand the common signs, symptoms, and behaviors. I agree that my child must be removed from practice/play if a concussion is suspected.* I understand that it is my responsibility to seek medical treatment if a suspected concussion is reported to me.* I understand that my child cannot return to practice/play until providing written clearance from an appropriate health care provider to his/her coach.* I understand the possible consequences of my child returning to practice/play too soon.* Information Packet is located under Documents at www.nkya.com.https://bsbproduction.s3.amazonaws.com/portals/6912/docs/2016_nkya_headsupconcussion.pdf
Coach / Player Request
Amount Paid Check # Accepted By: Date
Division
I, the parent/guardian/participant, in consideration of being allowed to participate in any way in the NORTHERN KENTUCKY YOUTH ASSOCIATION (hereby known as N.K.Y.A.) sports/activities program and related events and using the facilities provided by N.K.Y.A. does so at his/her/my own risk. N.K.Y.A., its board of directors, volunteers, agents, shall not be liable for any damages whatsoever arising from any personal injury or property loss sustained by participant and his/her/my family in or about any programs provided by the N.K.Y.A. I acknowledge that I am aware of the risks inherent in participating in the N.K.Y.A. programs/activities and understand that they may require physical exertion; and could potentially lead to injuries that may cause permanent disability and/or death. Participants and parents assume full responsibility for all injuries and damages which may occur in or about any programs and on any premises that N.K.Y.A. uses. He/she/I do or does hereby fully and forever release, discharge, and hold harmless the N.K.Y.A., all associated facilities and its owners, employees and agents from any and all claims, demands, damages, right of action, present or future resulting from or arising out of any person's participation in any programs/activities. Also, waiver all rights to any photos taken for use in any Northern Kentucky Youth Association publication.
Signature
Coach Requested
Current Age
Mailing Address & EmailP.O. Box 6748
Florence, KY [email protected]
BASEBALL Registration FormVisit us online at: www.nkya.com
Northern Kentucky Youth Association
Participant Information
Date
Contact Phone Number
Mother's Name Father's Name
Contact Information (Must complete if participant is a minor)
School
Jersey Sizes (please select one)
Waiver / Exclusion Clause (Please read carefully and sign below)
First Name
Zipcode
Last Name
Address
Date of Birth
City