ROCKY HILL BASEBALL Fall 2010
ONLINE REGISTRATION
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Last Name:
First:
MI:
Birth Date:
Address:
City: , TN
Zip:
School:
Grade:
Seasons in this sport:
Seasons in other sports:
Played on the Rocky Hill
team in Spring 2010 in the (5,6) (7,8) (9,10) (11,12) (13,14) age group.
Do you have medical insurance? (yes or no)
Carrier:
#:
Doctor's Name:
Phone:
Please list any medical condition(s), disabilities, present injuries, heart or resiratory illness
or other conditions that may affect this child's ability to play:
Father/Guardian
Last Name:
First:
Home Phone:
Mother/Guardian
Last Name:
First:
Home Phone:
I am interested in volunteering for:
Emergency Authorization
If there is an emergency during participation in this program and I or another parent or guardian is not present, I authorize
treatment and/or care at any hospital and I hereby authorize the volunteers and staff of this program as my agents. If
I can't be reached please contact the following person who is hereby authorized on my behalf:
Emergency Contact:
Phone:
DISCLAIMER, ASSUMPTION OF RISK AND WAIVER:
To accept registration and permit participation in Knoxville City programs by the named participant, I, the parent or guardian
of the participant, hereby give my consent and agree to release, indemnify, and hold harmless Knoxville City, its officials,
coaches, representatives and volunteers from any claim arising out of injury to the named participant. For myself and on
behalf of my heirs, assigns and next of kin, I acknowledge that participation in this program may include travel, participation
on adverse field conditions, and risk of physical injury or death. For myself and on behalf of my heirs, assign the next of kin,
I willingly and voluntarily accept and assume all such risks of participation. I hereby release, discharge and agree to hold
harmless Knoxville City, its employees, volunteers, officials, sponsors and other representatives from any and all claims,
demands, costs, expenses and compensation arising out of or in any way related to any injury or other damage that may result
to the particpant in the Knoxville City sponsored activity.
Insurance Acknowledgement
I acknowledge that Knoxville City provides limited, secondary medical insurance as a supplement to my primary medical insurance
and will serve as primary coverage only in the event I have no medical insurance (please see Knoxville City for limits of
insurance coverage and deductible).
League Eligibility is determined by the player's age on April 30, 2011.
Parents may request that a player be placed in an older league (no player will be allowed to
play in a lower age classification), but approval to do such shall be at the sole discretion and
judgement of the Board of Directors of the Rocky Hill Baseball League (Commission).
The Commission reserves the right to make all team assignments. Any player refusing such
assignment may forfeit their playing privileges for the balance of the season.
***Please bring payment ($70 for all leagues)
Or you can instead mail your check to the following address:
Rocky Hill Baseball
***You will be contacted by the your League's Commissioner regarding his receipt of this registration.
***“Please contact Ted Hotz at
thotz3432@comcast.net if you have not
been contacted within 36 hours as to the receipt of your online registration form.
After submitting the form, you will return to this page.
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