Saturday - 02/11/2012

12:00 PM		Spring Registration

Lakewood Youth Baseball

League Registration Form

* required fields

PLAYER INFORMATION

*First Name:
Middle Name:
*Last Name:
*Date of Birth:	(mm/dd/yy)
*Address:
*City:
*Zip:
*Home Phone:

*Division:	Tball (5 & 6) Minors (7 & 8 pitching machine) Farm (9 & 10 kid pitch) Varsity (11 & 12)

Is this player new to Lakewood Youth Baseball? YesNo
2011 Team: (if applicable)
2011 Coach: (if applicable)
*Shirt Size: Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X-Large Adult 2XL	Pant Size:(if applicable) Youth X-Small Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X-Large No Pants
NOTE: Uniform pants are NOT included in the registration fee, however LYBA will supply pants for an additional $15, if desired

PARENT/GUARDIAN INFORMATION

*Father's Name:		Cell Phone:
*Mother's Name:		Cell Phone:
Email:

SIBLINGS PLAYING @ LYBA

Name	Age	Team
1.
2.
3.

EMERGENCY INFORMATION

*Friend/Relative:		*Home Phone:
*Relationship to Player:		Cell Phone:
*Primary Physician:		*Physician Phone:
*Known Medical Conditions:

VOLUNTEER OPPORTUNITIES
I am willing to:	Coach a Team Be a Team Parent Work the Concession Stand Do Field Maintenance Umpire Games Help with League Management Help with Fundraising Other

CONSENT

* I/We agree that the above information is true to the best of my/our knowledge. I/We authorize my child to play responsibly in
the Lakewood Youth Baseball Assoc. The Lakewood Little League exists to provide children who are interested in
participating in a positive and enjoyable recreational experience. The Lakewood Little League is structured so that all children
are given the opportunity to participate regardless of disability, race, color, creed, national origin, gender, sexual preference,
religious preference, or economic status; and every effort will be made to provide a safe, positive, and enjoyable experience.
* I/We, the parents/guardians of the above-named candidate for a position on a Lakewood Little League team, hereby give
my/our approval to participate in any and all Little League activities, including transportation to and from the activities.
* I/We know that participation in baseball may result in serious injuries and protective equipment does not prevent all injuries of
players, and do hereby waive, release, absolve, indemnify, and agree to hold harmless the Lakewood Little League, Little
League Baseball, Incorporated, the organizers, sponsors, supervisors, participants, 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.
* I/We understand that the Lakewood Little League carries accident insurance through Little League Baseball, Incorporated.
I/We have received and read/will read the letter to parents about Little League Insurance.
* I/We agree that our child (candidate) may be required to try out for a team. If such does not attend at least 50% of the tryouts,
local Board of Director's approval is required for such candidate to be placed on a team.
* I/We agree to provide proof of legal residence (as defined by Little League Baseball, Incorporated) and age. I/We understand
that our child (candidate) must be eligible under the residence and age regulations of Little League Baseball, Incorporated, to
participate in Lakewood Little League, and that if any controversy arises regarding residence and/or age, the decision of the
Charter Committee in Williamsport shall be final and binding. I/We further understand that if any participant on a Little League
team does not qualify for participation in the league based on residence (as defined by Little League Baseball, Incorporated)
and/or age, such participant and/or team on which he/she participates be found ineligible, and forfeit(s) and/or suspension of
Tournament privileges may be decreed by action of the Charter Committee or Tournament Committee.
* I/We will furnish a certified birth certificate of the above-named candidate to League Officials, if not already on file.
* I/We understand that the Lakewood Little League has adopted a policy that holds everyone associated with the program,
Player Information:
(Please Print)
Emergency Information:
including parents, responsible for their behavior to help ensure high quality programming. It's imperative for the continued
success of the Lakewood Little League that parents become involved, (i.e. Fund raisers, concession stand, field preparation,
litter control & etc.). I/We have read/will read and understand the Parents' Code of Ethics and will do my best to follow and
enforce this statement.
* I/We understand that all League games will be played at Evan's Park on Refugee Rd. in Hebron. The League Season will run
approximately from April to the middle of June, with All-Star teams playing in July.
* I/We understand that the League mission statement is to continue the great tradition of Lakewood Baseball, teach the
fundamentals of the game, the importance of sportsmanship, and to build self-esteem.
* I/We also understand that I/We are financially responsible for any destruction of League property on loan to my child while my
child is a participant of this League, (ex. uniform, equipment, facilities, etc.)
* I/We understand that this League is comprised of ALL VOLUNTEER COACHES, UMPIRES AND CONCESSION STAND
WORKERS. By signing your player up with this league, you are agreeing to support this league. We would appreciate your
support through Coaching, Umpiring, helping maintain the facility, preparing the fields, and/or WORKING IN THE
CONCESSION STAND. Each team will be assigned two time slots in the Concession Stand and that team must provide
workers for the stand during your assigned schedule (NO EXCEPTIONS).

*Do you agree to the terms and conditions above?
No, I do not agree
Yes, I agree

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Hebron Weather Forecast, OH (43025)

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LYBA NEWS:

02.01.12 2012 Spring Sign-Ups Announced!

02.08.11 LYBA Is Now Little League Sanctioned!

Evans Park
1801 Refugee Rd.
Hebron, OH 43025

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