2018 PHYSA Registration Form

Player Name:*
Gender:*
Address:*
Player Date of Birth:*
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Does the player have any medical conditions we should be aware of? Ex: Asthma, Allergies etc. If so, please describe here:*
Parent/Guardian Name:*
Parent/Guardian Phone Number:*
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Parent/Guardian E-mail:
Emergency Contact Name:*
Emergency Contact Phone Number:*
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Are there any other individuals who are registering that you would like your child to play with this season? If so please list them here (first & last names, maximum of 3 players):
Preferred Position:
Has your child played organized baseball/softball before?*
Would you like to volunteer to coach your child's team this year?*
I, the undersigned parent/guardian, having applied to the Parkwood Hills Youth Softball Association (“PHYSA”) on behalf of my child or ward for membership in the PHYSA, and in consideration for acceptance by the PHYSA of my application, do hereby give permission for my child or ward to participate in the PHYSA and their programs including all scheduled outings, unless I advise in writing to the contrary. Having investigated the activities and resources of the PHYSA to my satisfaction, I understand that due care and attention will be given to the safety of all participants including my child or ward, but that the PHYSA, its officers and directors, staff and volunteers cannot be held liable for any injury or loss, howsoever caused, and I release the PHYSA, its officers and directors, staff and volunteers on behalf of my child or ward, from any liability and from all claims arising, directly or indirectly, from participation by my child or ward in PHYSA activities. I further understand that the PHYSA reserves the right to remove my child or ward from the program if the PHYSA deems it necessary to ensure the safety and well being of other participants. *