JAB Travel Ball Registration/Medical Form For 2010-2011

Name: D.O.B: Age:

Jersey Size:

Hat Size: Batting Glove Size:

Jersey No: (Request Only)

Address:

City: State: CA   Zip:

Home Phone: Date: ___________________________(Today’s)

Father:

Phone:

Cell Phone:

Email:

Mother:

Phone:

Cell Phone:

Email:

If your child has any health problems please explain:

Name of Health Insurance Company:

Family Physician:

Family Physician’s Phone Number:

Hospital Name:

Hospital Address:

Hospital Phone:

Consent:

• I am the parent/guardian of the child enrolling in this team.
• I understand that I have to pay $132.00 startup fee that covers Insurance, Hat, Jersey and conditioning fees for the first
  month and $78.00 per month there after, that will cover Insurance, conditioning/practice costs per month.
• JAB staff will try to schedule 1 tournament per month (paid by team sponsor), any additional tournaments in a month
  will be calculated based on tournament fee divided by total players.
• In the event of an injury, I give Steve Miller permission to reach my family physician at the name and number listed
  above and/or to transport and treat my child, the child of which this application is enrolling, at the nearest
  hospital/professional medical facility.
• I understand that participation in this team may result in serious injuries. Protective equipment does not prevent
  all injuries. I herby waive the option of holding JAB Staff, organizers, sponsors, supervisors, participants, and
  transportation drivers, responsible from any event or activity leading to injury whether a result of negligence or
  accident, except to the extent provided by liability insurance.
• I understand that I am required to provide a copy of the child’s birth certificate upon enrolling in this team.
• I understand that there is no refund of payments or fees after first participation date.
• I understand the monthly payment amount as out lined by this application.
• I understand that practice and game/tournament times are subject to change at the desire of the
  JAB Staff.

Activities:

• Please if there is a tournament/game and you can not attend notify Steve Miller with in 7
  days before tournament/game date.
• For games be at the field 1 hour before game time.
• Coaches will be responsible for the team during tournaments/games.
• No parents allowed in the dugout (No Exceptions).

Parent/Guardian Signature: ______________________________________________________________

Make check payable to Steve Miller