Player Information
PLYSA League: *
Flag Football
Registrations Open
Cheer
Registrations Open
Soccer
Registrations Open
Tiny T-Ballers
Registrations Closed
First Name: *
Middle Name:
Last Name: *
Address: *
City: *
State: *
Zip Code:
Phone Number: *
Parent Email:
School: *
Grade: *
Birthdate: *
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Sex: *
Male
Female
Shirt Size:
Small
Medium
Large
X-Large
Parent of Guardian Information
Parent/Guardian #1
Name: *
Home Phone: *
Cell Phone: *
Parent/Guardian #2
Name:
Home Phone:
Cell Phone:
Agreement to Terms
Checked all the boxes below. By checking the boxes you agree that you have read, understand and agree to the terms listed. You must check all boxes to proceed.
I/We, the parent/guardians of the above-named player hereby give my/our approval to participate in any and all PLYSA activities.
Parental Consent #1: *
Checked
I/We know that participation in baseball may result in serious injuries and protective equipment does not prevent all injuries to players, and do hereby waive, release, absolve, indemnify, and agree to hold harmless the PLYSA, the organizers, sponsors, supervisors, participants, the board members, and persons transporting my/our child to and from activities from any claim arising out of any injury to my/our child whether the result of negligence or for any other cause.
Parental Consent #2: *
Checked
I/We agree to provide proof of legal residence and age. I/We understand that our child must be eligible under residence regulations of the PLYSA to participate in the PLYSA and that if any controversy arises regarding residence and/or age, the decision of the PLYSA shall be final and binding.
Parental Consent #3: *
Checked
I/We will furnish a certified Birth Certificate of the above-named candidate to League Officials upon request.
Parental Consent #4: *
Checked
I/We understand that unwelcome behavior of parents, such as voicing loud uncomplimentary opinions of umpires, managers or players, smoking and/or drinking alcohol, fighting or provoking a fight is not condoned at PLYSA games and can be cause for player and/or parent/guardian expulsion from PLYSA field grounds.
Parental Consent #5: *
Checked
I/We will make every effort to make my/our presence at the games and practices a source of encouragement for the players, volunteer managers/coaches, and volunteer umpires, and not subject them to harsh criticism.
Parental Consent #6: *
Checked
I/We understand the importance of parent involvement in this volunteer program and will do my/our part to lend a hand in fund raising, facility maintenance, snack bar labor, and other areas where our help is needed.
Parental Consent #7: *
Checked
I/We agree to allow the use of our childs pictures on the PLYSA website and other PLYSA advertisements and publications.
Parental Consent #8: *
Checked
I/We understand that our child will not be added to the player roster for team selection until all forms have been submitted and registration fees have been payed in full.
Parental Consent #9: *
Checked
I/We agree to the following: If I/We remove a child from any PLYSA activity after registration and payment have been submitted, but before the first practice, I/We are entitled to a refund of the registration fees paid minus a $25.00 fee. If I/We remove a child after the first practice, for any reason, I/We forfeit any and all registration fees paid, and no refund will be given.
Parental Consent #10: *
Checked
Volunteering items that interest you:
Select one or multiple:
Manager(v)/
Coach(v)/
Team Parent(v)/
Field & Park Maintenance/
Clean Up Days/
Other
If other, please explain:
(v) Denotes a Volunteer Application is required.
Medical Release & Consent for Treatment
Parent or Guardian Authorization:
In case of emergency, if family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel. (i.e. EMT, First Responder, E.R. Physician).
Family Physician: *
Phone: *
Address: *
Hospital Preference: *
In case of emergency primary contact:
Name: *
Phone: *
Relation to Player: *
In case of emergency secondary contact:
Name:
Phone:
Relation to Player:
Please list any allergies/medical problems, including those requiring maintenance medications. (i.e. Diabetes, Asthma, Seizure Disorder).
List medical dianosis, medications, allergies or special needs:
Date of last Toxoid Booster:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
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8
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11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
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1908
1907
1906
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1904
1903
1902
1901
1900
Warning: Protective equipment cannot prevent all injuries a player might receive while participating in sporting and recreational activities.
You will be required to sign a Consent for treatment form in person before your child will be eligible to play. This may be done at the first practice or meeting.
By clicking on the submit button below, you agree that you are the above childs legal parent/guardian and that you agree to all the terms indicated.
Your Email Address:
Please enter the letters to the right in the field below:
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