To save this file, click on "file" in the menu, and go to "save as." THis should save this file as a .txt file automatically. ***YOU MAY NEED TO EXPAND (MAXIMIZE) THIS WINDOW, AND/OR TAKE OFF WORD WRAP (click on format on top menu) TO HAVE THE LAYOUT WORK PROPERLY!** Also, please be aware NO registration forms will be accepted online. Forms must be handed in with payment to a designated person. For a list of these people, please call Dave Cochrane at 866-7332. NO EXCEPTIONS!! 2005 Registration Form 1.Player Name: _______________________________________ First Last 2.Address: __________________________________________ Phone #: ( ) ____-_____ Email: ________________ Address City 3.Birthday: Year: 19___ Month: ____ Day: ____ Gender (M/F): ____ 4.Please check (X) if you play pitcher, catcher, or both: {__} Pitcher {__} Catcher 5. If possible, we will attempt to accommodate a request for teammates. However, these requests are not guaranteed. Friend #1: ____________________________________ Friend #2: _____________________________________ First name last name first name last name **Please be sure to make a note beside your request if it is a requirement for rides, or siblings, etc. Again, there is no guarantee, but extra attention will be paid to it!! 6. Coaches and volunteers are always required. If you would like to be a player-coach, or a parent would like to coach, fill in appropriately. I am not sure who wants to coach, so let me know if you are interested! Name: _______________________ Phone #: ( ) ____-_____ {__} Coach {__} Assistant coach {__} Other ___________ 7. Player’s preferred position: 1st choice - _________ 2nd choice - _________ 3rd choice - ________ 8. Medical concerns we should be aware of: _________________________________________________________________________ 9.How many games do you expect to miss (see tentative schedule on website)? {__} 0-2 games {__} 3-5 games {__} 6+ games 10. I/we agree to abide by the rules, regulations, policies and procedures of the City of Ottawa and the contract holder and agree to use the facility and equipment in a manner consistent with its intended use and application. Sports and physical fitness programs are designed predominantly for healthy individuals. Participation in sport and physical activity programs involves a risk of normal injuries. An individual's participation will be deemed to indicate acceptance of such risks. Therefore, the City of Ottawa and the contract holder accept no responsibility for such normal activity related risks. I agree that in the event of a personal injury or property loss, as a result of my participation in this program, I accept full responsibility and I will not hold the City of Ottawa and the contract holder, its volunteers, contractors, agents, or coaches liable. I am aware of the nature and effect of the Release of Liability, Waiver of Claims and Assumption of Risks and Indemnity Agreement that I am signing. I acknowledge to having read this entire agreement prior to having signed it. PLAYER Signature (if player is 18 years of age and older): ___________________________ Date: ___/___/05 dd mm By signing this document, I/my child understand, my child will be assuming certain legal risks. You and your child must acknowledge having read, understood and agree to the conditions contained in this Agreement My child (named on opposite side of form), a minor, has my permission to participate in the sports or physical fitness program identified above in section 10. ______________________________________ ___________________________________ _____/____/05 Parent/Legal Guardian, print your name Signature of Parent/Legal Guardian MM DD ----------------------------------------------------- -Deadline for registration form is Sunday, June 19th, 2005. -PAYMENTS: >Cheque* payable to Dave Cochrane OR >Cash *May be post dated to July 3rd, 2004 -Players will be notified by at the Draft on July 3rd what time their game is at on July 5th. -Be prepared to play either game! Please be prepared to play at either 6:30pm or 8:30pm on Tuesday July 5th!! Check website for details (www.midgetsoftball.freeservers.com) ***Due to necessity of needing a specific amount of players for the league, $25 will be kept in the event of a refund before the season begins. NO refunds will be given after the season has begun.