Players First Name

Players Last Name

Players Date of Birth

Parent/Guardian First Name

Parent/Guardian Last Name

Parent Phone Number

Parent/Guardian Email

Parent/Guardian First Name #2

Parent/Guardian Last Name #2

Alternate Parent/Guardian Phone Number

Emergency Contact First and Last Name (Other than Parent)

Emergency Contact Phone Number

Parent: Will you Coach

Yes

Maybe

Parent: Will you volunteer in other TBYSA areas (Team Help, Concession, Field Maintenance)

Yes

Does your child have any medical issues that would require a Doctor's release before playing this sport.

Top Three Preferred Numbers

Family Doctor Name and Number

Family Hospitalization Insurance

Parents (Guardian’s) Agreement and Authorization:

By checking the box below, I confirm that the above is true to the best of my knowledge. Furthermore, I agree to encourage my child to use good sportsmanship and I agree to show good sportsmanlike conduct as a fan or volunteer. I also give permission to the Tom Bean YSA to give the above phone numbers to coaches, assistant coaches, players, and parents of players. I understand that photos of my child may be taken during the sporting event and may be posted on the internet. Finally, by my signature below, confirm that my child has permission to play in the above sport, and I also confirm that I am the parent, guardian, or managing conservator with the authority to authorize the child’s participation in the above sport.

In case of emergency, I hereby authorize a representative of Tom Bean Youth Sports Association to seek medical attention for my child.

I agree to the above medical terms.

Player’s Agreement:

I agree to be loyal to my team and coaches, to be present at practice sessions and games, and to obey all rules. I will always do my best and be a good sport whether or not I am in the game.

I accept terms & conditions

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