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Application Form for 15-18 year old Summer Baseball players on Martha’s Vineyard
$50 Deposit due on signing
Please make checks payable to: Vineyard Senior Babe Ruth League
PO Box 1123 West Tisbury, MA 02575
Player’s Name___________________________ Born________/________/___________
Parent’s Name___________________________ Phone___________________________
Island Mailing Address________________________________________________________
E-mail Address______________________________________________________________
Baseball Position____ Throw____ Bat____ League age based on the chart below:______ 
I, the legal guardian of the above candidate for a position on a Babe Ruth team, hereby give my approval to participate in any and all Babe Ruth activities, including transportation to and from the activities. I know that the participation in baseball may result in serious injuries and protective equipment does not prevent all injuries to players, and do hereby waive, release absolve, indemnify and agree to hold harmless the local Vineyard Babe Ruth League, Babe Ruth Baseball Incorporated , the organizers, sponsors, supervisors, participants, and persons transporting my child to and from activities from any claim arising out of injury to my child whether the result of negligence or for any other cause, except to the extent and to the amount covered by accident or liability insurance. I agree to return upon request the uniform and other equipment issued to my child in as good a condition as when received except for normal wear and tear.
Parent or Guardian_____________________________________________________________
Please indicate any physical limitations (allergies, hearing, sight,etc…)________________________________________________________
________________________________________________________________________
Would you interested in helping coach? ______________________
Board Member?________________________
MEDICAL HISTORY, INFORMED CONSENT & RELEASE FORM
I hereby give permission for ____________________________________________ to participate in the Vineyard Senior Babe Ruth League during the athletic season beginning________________, _______. Further, I authorize the coaching staff to provide emergency medical treatment of an injury to or illness or my child if qualified medical personnel consider treatment necessary. I further authorize any qualified, licensed physician to render medical treatment which in his/her judgment may be deemed necessary in the care of: ______________________________________________________________________
(Print Player’s Name)
This authorization is only granted if I cannot be reached and a reasonable effort has been made to do so.
Date: _________________________ Parent of Guardian: _________________________
Address: ______________________________________ Phone: ( ) _____-_________
Family Physician: _______________________________ Phone: ( ) _____-_________
Child’s Physician: _______________________________Phone: ( ) _____-_________
Medicines Child currently taking: ____________________________________________
Pre-existing medical conditions (allergies, chronic illnesses, etc.) ___________________
________________________________________________________________________
Date of last tetanus shot: ___________________________________________________
Other person(s) to contact in case of emergency: (Name and Phone)
______________________ : ________________________________________________
Emergency contact’s relationship to child: _____________________________________
Other things an attending physician should know: _______________________________
_______________________________________________________________________
INSURANCE INFORMATION:
Insurance Company: ______________________________________________________
Identification or policy number: _____________________________________________
Subscriber’s Name: _______________________________________________________
Place of Subscriber’s Employment: _________________________ Phone: ___________
My child and I are aware that participating in baseball or softball is a potentially hazardous activity. I understand that my child is not covered by any insurance plan through the association and do hereby waive, release, absolve, indemnify and agree to hold harmless the association and any of its administrators, coaches, or other participants in the event of an injury or illness to my child that occurs during travel to, from or during the conduct of all practices, games and special event. I assume all risks, including but not limited to falls, contact with other participants, being hit with the ball, the effects of weather, traffic and other reasonable risk conditions associated with sport. All such risks are known and understood by me.
Child’s Signature: _____________________________________ Date: ______________
Parent’s Signature: ____________________________________ Date: ______________
For more information, please contact Coach
Simmons
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