Athlete's Name *

First Name

Last Name

Athlete's Birthdate *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Physician *

First Name

Last Name

Phone

(###)

###

####

Parent/Guardian's Name *

First Name

Last Name

Phone *

(###)

###

####

I understand that PY Youth Baseball and Softball Is in great need of volunteers. I am interested in volunteering. (Check all that apply.) *

Coaching

Board Member

Fundraising

Dugout Supervision

Small Jobs (organizing paperwork, helping with registration, etc.)

I cannot volunteer at this time.

Parent/Guardian Name

First Name

Last Name

Phone

(###)

###

####

Emergency Contact (in case parent/guardian cannot be reached) *

First Name

Last Name

Phone *

(###)

###

####

As a Parent/Guardian of the child aforementioned in this form, I fully understand and acknowledge that (a) risks and dangers exist in use of baseball and softball equipment and participation in baseball and softball activities; (b) my child, or children's, participation in such activities and/or the use of such equipment may result in their injury or illness including, but not limited to, bodily injury, disease, strains, fractures, partial and/or total paralysis, eye injury, blindness, heat stroke, heart attack, death or other ailments that could cause serious disability; (c) these risks and dangers may be caused by the negligence of participants, the negligence of others, accidents, breaches of contract, the forces of nature or other causes. These risks and dangers may arise from foreseeable or unforeseeable causes and (d) by my child's/children's participation in these activities and/or use of equipment. I hereby assume all risks and dangers and all responsibility for the losses and/or damages, whether caused in whole or in part by the negligence or other conduct of the owners, agents, officers, Penn Yan Youth Baseball and Softball Board of Directors, or by any other person. I, on behalf of my child(ren), myself, my personal representatives and my heirs, hereby voluntarily agree to release, waive, discharge, hold harmless, defend and indemnify the Penn Yan Youth Baseball and Softball Board of Directors and it's owners, agents, officers, and volunteers from any and all claims, actions or losses for bodily injury, property damage, wrongful death, loss of services, or otherwise which may arise out of my child's use of baseball and softball equipment or my child(ren)'s participation in baseball or softball activities. I specifically understand that I am releasing, discharging, and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by the owners, agents, officers, or the Penn Yan Youth Baseball and Softball Board of Directors. I HAVE READ THE ABOVE WAIVER AND BY CHECKING THE BOX BELOW, AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE THE PENN YAN YOUTH BASEBALL AND SOFTBALL BOARD OF DIRECTORS FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OF ANY OTHER CAUSE. *

I understand and agree.

I give permission for my athlete's photo to be taken and used for PY Youth Baseball and Softball Promotions, Website and Social Media Sites. *

I agree.

I read the PYYBS parent and spectator code of conduct, and agree to abide by and follow all rules and regulations therein. I also agree that, if necessary, I will abide by any disciplinary decision made by the Penn Yan Youth Baseball and Softball Board. *

I read it, and I agree.