Coulee Area Youth Baseball and Softball
Sign-ups!!
Thursday, March 19th
5:00-7:00 pm
at Lake Roosevelt Elementary cafeteria
or
Mail registration form and payment to:
CAYBA
Box 6004
Grand Coulee, WA 99133
(Must be received by March 20th)
Coaches will contact team members about practice schedules.
Practice will begin after Spring Break
Any questions call: Shayla Picard 631-1241
Tera McGuire 631-4652
Or email: couleebaseball@yahoo.com
Coulee Area Youth Baseball/Softball 2015
Sign ups:
Thursday, March
5:00-7:00 Lake Roosevelt Elementary cafeteria
Or mail registration form, concussion form, and payment to CAYBA Box 6004 Grand Coulee, WA 99133
19th
Player Name___________________________________________ Phone________________________________________________
Mailing Address_________________________________________ City________________________________________________
Birthday (Month, day and year born)_________________________Played 2014? Y__________________
N__________________
What team/coach? _______________________________________Placement preference (not guaranteed) _____________________
Medical Condition, explain needs (if any)__________________________________________________________________________
BOYS
GIRLS
T-Ball (co-ed) ages 4-5 _____________
T-Ball (co-ed) ages 4-5 _____________
Rookies (co-ed) ages 6-7_____________
Rookies (co-ed) ages 6-7_____________
Minor Baseball ages 8-10____________
Minor Softball ages 8-10_____________
Major Baseball ages 10-12___________
Major Softball ages 10-13____________
Age on May 1, 2015__________
Age on Dec. 31, 2014
________
**Parents wishing for a child to play up a division will have to appeal the board with reasons for request. Players will be placed by age
w/out appeal.
Shirt Size: Small 6-8_______Med 10-12_______Large14-16_______
Adult Small_______Adult Med_______ Adult Large_______Adult X-Large_______
Parent willing to: Coach? _______Umpire?_______Committee Member?_______
I, the parent or guardian of the above named candidate for a position on a Coulee Area Youth Baseball Association Team, do
hereby give my approval to his/her participation in any and all Coulee Youth Baseball Association activities during the current season.
I assume all risks and hazards incidental to such participation including transportation to and from activities. I do hereby waive,
release, absolve, indemnify, and agree to hold harmless the local Coulee Area Youth Baseball Association, its Organization, Sponsors,
Supervisors, Participants, Coaches, Umpires, and persons transporting my child to and from the activities for any claim arising out of
any injury to my child except to the extent and in the amount covered by accident or liability insurance. I agree to return, upon request,
the uniforms and other equipment issued to my child in as good condition as when received, less normal wear and tear. I will furnish
a certified birth certificate of the above named child upon request of CAYBA officials.
Signature of Parent/Guardian ______________________________________Date_____________________
Print Parent/Guardian Name_________________________Email address:___________________________
Fees:
League Use:
T-BALL $35_______________
TOTAL PAID_______________
ROOKIES $35_____________
CHECK #__________________
MINORS $40______________
CASH_____________________
MAJORS $45______________
TOTAL DUE________________
$5 Sibling Discount_________
Make checks payable to: CAYBA
CONCUSSION FORM SIGNED
Grand Coulee Dam School District
Concussion Information Sheet
A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a
blow to another part of the body with the force transmitted to the head. They can range from mild to severe and can disrupt the way
the brain normally works. Even though most concussions are mild, all concussions are potentially serious and may result in
complications including prolonged brain damage and death if not recognized and managed properly. In other words, even a
“ding” or a bump on the head can be serious. You can’t see a concussion and most sports concussions occur without loss of
consciousness. Signs and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. If your
child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right
away.
Symptoms may include one or more of the following:
• Headaches
• Amnesia
• “Pressure in head”
• “Don’t feel right”
• Nausea or vomiting
• Fatigue or low energy
• Neck pain
• Sadness
• Balance problems or dizziness
• Nervousness or anxiety
• Blurred, double, or fuzzy vision
• Irritability
• Sensitivity to light or noise
• More emotional
• Feeling sluggish or slowed down
• Confusion
• Feeling foggy or groggy
• Concentration or memory problems
• Drowsiness
(forgetting game plays)
• Change in sleep patterns
• Repeating the same question/comment
Signs observed by teammates, parents and coaches include:
• Appears dazed
• Slurred speech
• Vacant facial expression
• Shows behavior or personality changes
• Confused about assignment
• Can’t recall events prior to hit
• Forgets plays
• Can’t recall events after hit
• Is unsure of game, score, or opponent
• Seizures or convulsions
• Moves clumsily or displays incoordination
• Any change in typical behavior or personality
• Answers questions slowly
• Loses consciousness
What can happen if my child keeps on playing with a concussion or returns to soon?
Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play with the signs and
symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant
damage from a concussion for a period of time after that concussion occurs, particularly if the athlete suffers another concussion
before completely recovering from the first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact
syndrome) with devastating and even fatal consequences. It is well known that adolescent or teenage athlete will often under report
symptoms of injuries. And concussions are no different. As a result, education of administrators, coaches, parents and students is the
key for student-athlete’s safety.
If you think your child has suffered a concussion
Any athlete even suspected of suffering a concussion should be removed from the game or
practice immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how mild it seems or
how quickly symptoms clear, without medical clearance. Close observation of the athlete should continue for several hours. The new
“Zackery Lystedt Law” in Washington now requires the consistent and uniform implementation of long and well-established return to
play concussion guidelines that have been recommended for several years:
“a youth athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at
that time” and “…may not return to play until the athlete is evaluated by a licensed heath care provider trained in the evaluation and
management of concussion and received written clearance to return to play from that health care provider”.
You should also inform your child’s coach if you think that your child may have a concussion. Remember it’s better to miss one game
than miss the whole season. And when in doubt, the athlete sits out. For current and up-to-date information on concussions you can go
to: http://www.cdc.gov/ConcussionInYouthSports/
_______________________
Student-athlete Name Printed
_____________________________
Student-athlete Signature
_____
Date
_______________________
Parent or Legal Guardian Printed
_____________________________
Parent or Legal Guardian Signature
_____
Date