Join Taney Baseball!
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Please print out this page and complete one registration form for each child. Be sure to answer all questions. Your non-refundable fee should be payable to TYBA and mailed with this registration form. Please notate your child(s) name on the check. You may send one check for multiple registrations. Mail to:  Taney Youth Baseball League, 1835 Market Street, 12th Floor, Philadelphia, PA 19103

Child's Last Name, First & Middle Initial:______________________________________________________________

Age___________Date of Birth:_____________Home Telephone:________________ School Grade (Sept.'01):_________

Address:________________________________________ City, State & Zip:__________________________________

Mother's Name:________________________________ Address:____________________________________________

Phone:______________________________________ Work Phone:__________________________________________

Mother's e-mail address (if applicable):________________________________________________________________

Father's Name:__________________________________ Address:__________________________________________

Phone:______________________________________ Work Phone:__________________________________________

Father's e-mail address (if applicable):________________________________________________________________

Please check one:
Child lives with:  Mother   Father   Both Parents   Other (List name, address, phone,

In an emergency, if we can't reach you, whom do we contact? Name:_____________________________________________

Address:___________________________________ Phone:____________________Relationship__________________

Additional emergency info:___________________________________________________________________________

Circle if applicable, My child Must  practise:          Monday & Wednesday           Tuesday & Thursday

(Only select days if necessary. Our draft system can not guarantee that requests can be honored. A coach cannot draft your child
against your listed "must practice" days)

Legal & Fees

Childs Last Name, First & Initial_____________________________________________________________________

Sex:___________Height:_____________ Weight______________

I/we, the parents / guardians of the above named child, give permission for participation in any and all Taney Youth Baseball Association programs and activities. I/we understand that there are some risks involved with this sport and do assume all risks and hazards incidental to such participation, including transportation to and from the activities. In consideration of my child being permitted to participate, I / we do hereby waive, release and absolve the Taney Youth Baseball Association and its officers, teams, coaches, officials, sponsors, volunteers and supporters from all claims and liabilities, including liability for negligent acts, for any injury to my / our child or property loss which may occur during or in connection with league activities, except to the extent, and only in the amount, provided, by available accident insurance. I / we further agree to indemnify, defend and hold harmless those entities and individuals for any loss, liability or damages they incur due to my/our child's paricipation in any league activity. I/we acknowledge having read, understood and voluntarily signed this document and that no other representations or inducements have been made in regard to it, and specifically state that I/we intend to be legally bound by its provisions. I/we agree to return, upon request, any equipment or other items issued.

I/we do certify that the following represents the medical condition of the child applicant (check one):
No Medical Limitations
Medical, physical or emotional limitations. (Must be fully described. Children under routine
        physician's care must have a written certification of eligibilty from the physician.)

Registration alone does not make a child eligible. Enrollment must be confirmed by the coaching staff prior to participation of the child. If the child is judged ineligible, the registration fee will be returned. Taney Baseball reserves the right to continually assess the skill level of players in each division throughout the season, and to make transfers as may be deemed necessary (including the right to withdraw acceptance of a player), for the safety and welfare of the players and the League.

I/we would like to particpate in the following activities (check any that apply):
 Baseball Coach (Head Coach)  T-Ball Manager (Head Coach)
 Baseball Coach (Assistant Coach)  T-Ball Coach (Assistant Coach)
 Team Administrator  Help with mailings

Fee Schedule
Note: There is a discount of $10.00 for each additional child in the same family.
Application fee, $50.00 per child (payable by 2/15/2002) _______.___
Late fee of $15.00 per child (after 2/15/2002) _______.___

Additional Contributions:
Fair Share $40.00 contribution _______.___
Friend of TYBA, $100.00 contribution _______.___
Team Sponsor (logo on team jersey), $400.00 contribution _______.___
Other additional contribution _______.___
Total _______.___

Taney Youth Baseball Association is a 501(c)(3) Non-profit Corporation, Federal Tax ID#: 23-2746602

I/we give permission for my/our child to receive emergency medical treatment and to be transported to the nearest hospital should it be necessary. I/we also give permission for photographs of my/our child to be used for publicity purposes.

Date:_____________  Signature(s) of Parent(s) or Guardian(s)____________________________________________