Birth Date
Player Last Name
Mother Name
Father Name
Baseball Player On-Line Registration Form
2010 Registration is Open
Emergency Contact Name
Emergency Phone #
Emergency Phone #Special Needs
Home PhoneCell PhoneWork Phone Alt. Phone1 Alt. Phone 2
Cell PhoneWork Phone Alt. Phone1 Alt. Phone 2Street AddressApt. #CityStateZip
Apt. #CityStateZipE-Mail Address 1 E-Mail Address 2
E-Mail Address 2Player First Name
Sex
Program
Volunteer Options
Does your child have Asthma
Titan Youth Sports
Brooklyn Titans
Youth Baseball & Softball
Pay Registration Fees
Fee Schedule: $50.00 Uniform Fee Plus $100.00 Mandatory Fundraising
Indicate Child's Name at On-line Check Out or On Check or Money Order
RELEASE
In consideration of my child being allowed to play baseball and attend the related events and activities provided through the Titan Youth Development program I hereby acknowledge, appreciate and agree that:
The risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
1) For myself, spouse, and child, I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility form child's participation; and,
2) I willingly agree to comply with the program's stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child's readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and,
3) I myself, my spouse, my child and on behalf of my/our heirs, assigns, personal representatives and next of kin, hereby release and hold harmless Titan Youth Development, its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("Releases"), with respect to any and all injury, disability, death, or loss or damage to person or property incident to my child's involvement or participation these programs, whether arising from the negligence of the releases or otherwise, to the fullest extent permitted by law.
4) I for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, hereby indemnify and hold harmless all the above Releases from any and all liabilities incident to my involvement or participation in these programs, even if arising from their negligence, to the fullest extent permitted by law.
I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.
Indicate your agreement to the release by putting your initials in the box. The form cannot be completed unless you initial the box
Mail or Hand Deliver to:
322 E. 17th St.
Brooklyn, NY 11226
Pay With Check or Money Order
Pay On Line
