Belleville Khoury League PLAYER REGISTRATION FORM Register Online: www.bellevillekhoury.org Register In Person: January 27th (10am - 2pm), February 7th (6 - 8pm), or February 21st (6 - 8pm) Spring 2018 Baseball Softball Rookie Ball PLAYER INFORMATION (All Fields Are Required) Last Name: First Name: Address: City: Male Female Both Mother Father Guardian Y - S Y - M Y - L A - S A - M A - L A - XL A - XXL Date Of Birth: Gender: School Name: Shirt Size: (Specify Youth or Adult then S, M, L, XL, etc.) Zip Code: Lives With: PARENT / GUARDIAN INFORMATION (All Fields Are Required) Father / Guardian Last Name: Father / Guardian First Name: Home Phone: Mobile Phone: Work Phone: Email: Mother / Guardian Last Name: Mother / Guardian First Name: Home Phone: Mobile Phone: Work Phone: Email: REGISTRATION FEES Rookie Ball Baseball & Softball $80 $100 FREE FREE First Player Second Third Fourth.... PLEASE NOTE: All Baseball / Softball Registrations received after March 1st require $25 Late Fee ($15 for Rookie Ball). RETURNED CHECKS: A player will not be assigned to a team until the check and bank fees are paid in full. REFUND POLICY: No refund request shall be accepted after May 1st. Refund requests must be submitted in writing to the Belleville Khoury League Board of Directors. Is your child covered by a health insurance policy? Does your child have a medical condition? (If yes, please attach a medical release form your doctor.) Did your child play in another Khoury League last year? (If yes, where? ) If your child played in Belleville Khoury League last year, what was the name of the manager? If you are willing to manage your child's team, or assist another parent in doing so, please check here: Would you like for your child to remain on that team or be moved to a different team? Does your child intend to be rostered on another non-Khoury League team this season? How did you hear about us ? I, as a parent and / or guardian of the player named above, hereby give my approval for my child to participate in any and all league activities; and I do hereby waive, release, absolve, indemnify, and agree to hold harmless the Belleville Khoury League Incorporated, the chartering organization, its Board of Directors, Officers, appointed agents, organizers, sponsors, participants, and persons transporting my child to and from activities; for any claim arising out of an injury to my child whether the result of negligence or for any other cause. I further agree to return, upon request, any equipment issued to my child in as good condition as when issued, except for reasonable wear and tear. By signing below, I testify to the following: (a) that all of the information provided on this form is true to the best of my knowledge; (b) that I have read, understand, and will abide by the rules set forth in the Belleville Khoury League Code of Conduct and which is posted at both Belleville Khoury League facilities, a current copy of which will be provided upon request; (c) that I will abide by all rules and policies set forth by the Belleville Khoury League and the George Khoury Association of Baseball Leagues while attending all games, events, or functions. Amount Received: Date Received: Received By: Payment Type: Check Reference #: Division: TO BE COMPLETED BY BELLEVILLE KHOURY Parent / Guardian Signature: Date: Amount Due: Internet Facebook Newspaper Friend/Family Previously Played School Other… Yes No Same Different Yes Yes No Yes No Yes No Belleville Khoury League is a non-profit, 501(c)(3) organization proudly affiliated with the George Khoury Association of Baseball Leagues. Relationship: (Father, Guardian) Relationship: (Mother, Guardian) Birth Certificate Required to be on file with BK Belleville Khoury League | 411 West Monroe Street | Belleville, IL 62220 | (618) 277-5576 | [email protected] Operating since 1953, Belleville Khoury League has been serving the youth of our community for over 60 consecutive years. A - XXXL $70 $70 $90 $90