Fee Totals $_____________ Payment made by: Check #___________ Cash_________________
___ Staff Initials____________Receipt # __________ Age Division_______________________
Alma-Bacon County Recreation Department
Youth Baseball Registration Form Fee: (1st child $40.00) (2nd child $35.00) (3rd child $30.00)
Control Date is prior to May 1st
Jr. Flea W/M
Mite W/M
Ages: 5-6
Ages: 9-10
Flea W/M
Midget (live pitch)
Pony (live pitch)
Ages: 7-8
Ages: 11-12
Ages: 13-14
Please Print
Name________________________________________________________________
Birth Date_________________________________________________________
Address____________________________________City_______________Zip_____________
E-mail_______________________________HomePhone________________Cell_______________
Check if you live in Bacon County?___ City of Alma___ ($20.00 Fee for Non-Resident of Alma-Bacon)
If no medical insurance participant must purchase recreation Insurance for $6.00
Please select carefully, your selection will be the size ordered for your child
UNIFORM SELECTION: PLEASE CIRCLE
SHIRT SIZE: YS (6-8)
YM (10-12)
YL (14-16)
AS
AM
AL
AXL
AXXL
PANT SIZE
AS
AM
AL
AXL
AXXL
YS (6-8)
YM (10-12)
YL (14-16)
I understand that the uniform size which I order for my child will be the size he/she receives. If for any
reason the uniform size is Incorrect, I will be solely responsible for the replacement (order & cost)
Fees (Non-Refundable upon receipt) REFUNDS WILL ONLY BE GIVEN IF A PROGRAM IS CANCELED
ALL RETURNED CHECKS WILL HAVE A FEE OF $25.00
**Children must live or attend school in Bacon County to participate in All-Stars
WAIVER OF LIABILITY AND CONSENT
Important please read thoroughly
I hereby give permission for my child to participate in the youth sports program sponsored by the Alma-Bacon County
Recreation Department. I understand that there are risks involved with participation in youth sports programs, and hereby
assume all responsibility for all risk and hazards incidental to this program and transportation to and from this program,
and do so further release, absolve, indemnify, and hold harmless the Alma-Bacon County Recreation Department
(ABCRD), its administrators, officials, supervisors, sponsors, volunteers and all others involved with this program. Pictures
may be taken while participating in Alma-Bacon County Recreation Department activities for publicity. I hereby
acknowledge the ABCRD ZERO TOLERANCE policy in regards to appropriate behavior and actions at all events and
sporting venues. In the event my child becomes ill or injured during practices or games, I hereby authorize ABCRD or a
representative of ABCRD to consent to first aid or emergency medical treatment for my child. I certify that I have read,
understand and accept all of the information and conditions stated on this form and agree it is my responsibility to abide by
the rules and by laws of ABCRD and all state and local laws at any ABCRD function. I attest that all the information
provided hereon is true and correct.
Head Coaches will automatically get their child. Sponsor’s child will not be protected. Sibling will be placed on the
same team. Request will not be guaranteed. If your child does not get placed onto the (team/coach) requested,
withdrawing from the program will result in forfeiting your registration fee. Also, this is a great opportunity to learn
from a new coach. Remember, allSignature
of our coaches
are volunteers they all have something positive to provide.
Date____________
____________________________
If you have a coach you do not want to coach your child PLEASE put their name here:
_________________________________________________
______________________________/____________________________/______________________
Parent/Guardian Signature
Print Name
Date