2022 Registration & Waiver Form - Municipal Impact

2022 Registration & Waiver Form

Mail registration form to: Alma Neels 16815 10th Avenue East Moline, Illinois 61244 (309) 235-1241

Registration Must Be Turned In By March 15, 2022

You may hand deliver your registration form to The Village of Carbon Cliff ? 1001 Mansur Avenue, Carbon Cliff 61239

PLAYERS FIRST AND LAST NAME _________________________________________________________________________________________________________

ADDRESS ____________________________________________________________________________________________________________________________

HOME PHONE______________________________________________

CELL PHONE ________________________________________________

E-MAIL ADDRESS_____________________________________________________________________

BIRTHDAY _______ / _______ / ________

LEAGUE AGE ___________

SCHOOL ____________________________________________________

BASEBALL

SOFTBALL

T-BALL

SHIRT SIZE: Adult __________ Youth_____________

WE CANNOT GUARANTEE THE CORRECT SHIRT SIZE OR STYLE IF REGISTRATION FORM IS NOT RETURNED BY MARCH 15, 2022

MEDICAL PROBLEMS (ATTACH ADDITIONAL SHEET IF NEEDED) ____________________________________________________________________________

MEDICATIONS (ATTACH ADDITIONAL SHEET IF NEEDED) _________________________________________________________________________________

OPTION A: BASIC PLAN ? FLAT RATE FEES FOR BUY OUT

REGISTRATION FEES:

T-Ball = $40.00 ($20.00 Registration Fee + $20.00 Buy Out)

7?16 Years = $55.00 ($35.00 Registration Fee + $20.00 Buy Out)

Family Registration = $75.00 3+ CHILDREN IN ONE FAMILY (Plus $20.00 Per Player for Buy Out)

PARENT'S NAME (PLEASE PRINT)

_______________________________________________________

DATE: ______ / _______/ _______

OPTION B: FUNDRAISER ? FROZEN COOKIE DOUGH SALE

With option B, all players are required to sell a minimum of twelve (12) tubs. If a player sells all twelve (12) tubs the registration fee will be waived. If a player does not sell all twelve (12) tubs, then a registration fee will be prorated based on the number of tubs sold. *ALL COOKIE DOUGH ORDERS AND MONEY MUST BE TURNED IN BY APRIL 22, 2022 TO QUALIFY FOR THIS WAIVER. *

REGISTRATION FEES:

If All Twelve (12) Tubs Are Sold = $0.00

PARENT'S NAME (PLEASE PRINT) ________________________________________________

DATE:______ /_______ / _______

NEW PLAYERS MUST HAVE A COPY OF THEIR BIRTH CERTIFICATE BEFORE THE START OF THE FIRST GAME!!!

ALL COOKIE DOUGH ORDERS AND MONEY MUST BE TURNED IN BY APRIL 22, 2022

(READ & SIGN WAIVER ON BACK)

Carbon Cliff Sports Club

Release & Waiver

I / WE, THE PARENT(S) / GUARDIAN(S) OF THE PLAYER CANDIDATE, HEREBY GIVE MY / OUR APPROVAL TO PARTICIPATE IN ALL CARBON CLIFF SPORTS CLUB ACTIVITIES, INCLUDING TRANSPORTATION TO AND FROM THE ACTIVITIES.

I / WE KNOW THAT PARTICIPATION IN BASEBALL OR SOFTBALL WAIVES, RELEASES, ABSOLVES, INDEMNIFIES AND AGREES TO HOLD HARMLESS THE CARBON CLIFF LITTLE LEAGUE, LITTLE LEAGUE BASEBALL, INCORPORATED CARBON CLIFF VILLAGE, THE ORGANIZERS, SPONSORS, SUPERVISORS, PARTICIPANTS AND PERSON TRANSPORTING MY / OUR CHILD TO AND FROM ACTIVITIES FOR ANY CLAIM ARISING OUT OF ANY INJURY TO MY / OUR CHILD WHETHER THE RESULT OF NEGLIGENCE OR FOR ANY OTHER CAUSE.

I / WE AGREE TO RETURN UPON ANY OTHER EQUIPMENT ISSUED TO MY / OUR CHILD IN AS GOOD A CONDITION AS WHEN RECEIVED EXCEPT FOR NORMAL WEAR AND TEAR.

I / WE AGREE TO PROVIDE PROOF OF LEGAL RESIDENCE (AS DEFINED BY LITTLE LEAGUE BASEBALL, INCORPORATED) AND AGE. I / WE WILL FURNISH A CERTIFIED BIRTH CERTIFICATE OF THE ABOVE-NAMED CANDIDATE TO LEAGUE OFFICIALS.

I / WE ALSO HEREBY CONSENT AND AUTHORIZE EMERGENCY MEDICAL TREATMENT IN CASE OF INJURY. I / WE UNDERSTAND THAT ANY MEDICAL COSTS INCURRED WILL BE MY RESPONSIBILITY.

I / WE HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I / WE AM / ARE AWARE THAT I / WE RELEASING CERTAIN LEGAL RIGHTS THAT I / WE OTHERWISE MAY HAVE, AND I ENTER INTO THIS CONTRACT ON BEHALF OF MYSELF AND / OR MY FAMILY OF MY OWN FREE WILL.

SIGNATURE OF PARENT / GUARDIAN: ___________________________________________________________________________

EMERGENCY CONTACT: ______________________________________________________________________________________

EMERGENCY PHONE: ________________________________________________________________________________________

E-MAIL ADDRESS: __________________________________________________________________________________________

DATE: __________ / __________ / __________

Volunteers, Coaches, Workers, & Umpires Are Always Needed

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