BASEBALL MEDICAL RELEASE FORM

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QUEEN CITY ATHLETIC ASSOCIATION
2015 BASEBALL SEASON
www.queencitybaseball.org
816-796-4003
Important Dates:
Early Registration
Feb. 7th, 14th,21st & 28th 9:00am-1:00pm at Dick’s Sporting Goods,
39th St. in Independence
Mail in Registration Ends March 15th
You can also pay online at our web-site!!!!!!
The Fee to play in Queen City Baseball is:
T-Ball $60.00 (4 to 6) Machine Pitch $80.00 (7 and 8)
Bantam $100.00 (9 and 10) Midget $100.00 (11 and 12)
Junior $100.00 (13 to14)
NEW>>>>> 15/16 YEAR OLD LEAGUE $100.00
QCAA is a coed league and does accept both boys and girls.
Season begins Last week of April and ends early July ( If No Rain). A coach will
be contacting you once your child is placed on a team.
Games are played at Mill Creek Park in Independence.
Bantams, Midgets and Juniors compete in the Eastern Jackson County Interleague (Blue Springs, Oak Grove, Grain Valley, and Fort Osage). Some games may
be played outside of Independence for these teams.
There are 2 divisions in Bantams, Midgets and Juniors: Competitive and
Participation.
Competitive teams are put together by the coach (through tryouts or other
means) and play only teams in the Competitive Division.
Participation teams can be returning teams or newly formed teams that accept
players from the registration pool (no tryouts). These teams play only teams in
the Participation Division.
AGE DIVISIONS
NO FUNDRAISERS NO FUNDRAISERS
T-Ball 1
4 and 5 year olds
T-Ball 2
6 year olds
Machine Pitch 7-8 yrs old $80.00
Bantam
9-10 yrs old $100.00
Midget
11-12 yrs old $100.00
Junior
13-14 yrs old $100.00
15-16 yrs old $100.00 <<<NEW>>>>>
If you are unable to bring this form to early registration then please complete form and send
by mail with a Birth Certificate COPY. ALL FEES MUST BE PAYED IN FULL BY APRIL 18TH
QCAA; P.O. Box 142; Indep., MO 64051 (Check or Money Order only/NO CASH)
ONE CHILD PER FORM ONLY!!!!!!!
Player Name: ____________________________________ D.O.B.: _________________
Address: _______________________________________________________________
City: _____________________ State: ____________________ ZIP: ______________
Parent/Guardian:_________________________________________________________
Home Phone: ________________________ Alternate Phone: ______________________
E-Mail Address: _________________________________________________________
Age: ____________ Grade: ____________ School: _____________________________
Did you play last year? Yes _____ No _____ What League: _______________________
What Team: _________________________ Manager: ___________________________
Will parent/friend coach? Yes _____ No _____ If yes phone #: ____________________
OFFICE USE ONLY
Date Rec’d:____________ Check or MO #:_____________
Div: JTB T1 T2 MP1 MP2 B1 B2 M1 M2 J1 J2
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