Des Plaines Youth Baseball

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2021 DPYB Fall Ball Registration

PLAYER INFORMATION

* Full Name:

Street:

City:

State:

Zip Code:

Home Phone:

* Birthdate:

Gender:

* Age as of 5/1/21:

* Baseball Group:

PARENT/GUARDIAN #1

* First name:

* Last name:

* EMail:

Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

First name:

Last name:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Medical issues/allergies:

WAIVER INFORMATION

Parental Comments/Requests:

Parental Authorization - Medical Release For Participation In Des Plaines Youth Baseball
I, the undersigned, parent/guardian of the player named above for and in consideration of that player
being permitted to participate in the activities of the Des Plaines Youth Baseball, do hereby agree to release,
absolve, indemnify, and hold harmless Des Plaines Youth Baseball, its officers, directors and supervisors,
volunteers, coaches, participants, and all persons providing transportation to and from its activities, of and
from any and all claims, actions or causes of action of any nature arising out of or in the course of, such
participation including, but not limited to, practice sessions, games, contests, and transportation to or from
such. As parent/guardian I do herewith grant permission to the adult manager, coach, and business manager of
the team or organization to obtain medical care from any licensed physician, hospital, or medical clinic, for
the player named herein at such time as either parent or legal guardian cannot be contacted in person or by
telephone.
I further agree to abide by the terms of the following Parent’s Code of Ethics:
I hereby pledge to provide positive support, care and encouragement for my child participating in Des
Plaines Youth Baseball, I will encourage good sportsmanship by demonstrating positive support for all players,
coaches, and officials at every game, practice or other Des Plaines Youth Baseball, event. I will place the
emotional and physical well being of my child ahead of personal desire to win.
I will support coaches and officials working with my child in order to encourage a positive and enjoyable experience
for all. I will obey
posted rules on both public and private properties during the course of activities. I will encourage my child to
treat other players, coaches, fans and officials with respect. I understand Des Plaines Youth Baseball is enforcing a
zero tolerance policy regarding any player, parent, spectator, or coach who violates the Rules of Conduct. I
have read and agree to abide by the Rules of Conduct of Des Plaines Youth Baseball; as such rules may be
amended from time to time. (www.desplainesyouthbaseball.org)

I/we agree with the above *

Please indicate below what volunteer positions you would be interested in helping with.

Team Manager

Coach

Concessions

Baseball operations

Other:

* indicates required fields

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2021 DPYB Fall Ball Registration