REGISTRATION AND WAIVER FORMS

Buckland Recreation Registration

T-Ball/Softball/Baseball

Registration day: February 28th, 2022 from 6:00pm - 7:00pm @ the Buckland Fire Department, 105 N Main St., Buckland Ohio 45819

SIGN-UP DEADLINE: March 1st, 2024

Players name: _______________________________________________________

Gender: M F (circle one)

Age as of June 1st : ______________

Address: ____________________________________________________________

Parent/Guardian Information:

Address: ____________________________________________________________

Phone (preferred): ____________________________________________________

What role do you want as a parent?

Head coach: ___

Assistant coach: ___

Base coach: ___

Umpire: ___

Concession stand: ___

T-BALL

Boys and Girls
Ages 5 – 7
Games played Tuesday & Friday
$20 per child

BASEBALL, COACH PITCH

Boys only
Ages 7-8
Games dates TBA
$30

SOFTBALL, COACH PITCH

Girls only
Ages 8 – 10
Games played Monday & Wednesday
$30 per child

BASEBALL, MINOR LEAGUE

Boys only
Ages 8 – 10
Games played Monday & Wednesday
$30 per child

BASEBALL, MAJOR LEAGUE

Boys only
Ages 11 - 13
Games played Monday & Wednesday
$30 per child

SOFTBALL, FAST PITCH

Girls only
Ages 11 – 13
Games played Monday & Wednesday
$30 per child

Shirt Size:

Youth: S M L
Adult: S M L

I grant my son/daughter permission to play t-ball/baseball/softball and release the Buckland Recreation Club, its board, members, coaching staff and all instructors from all responsibility pertaining or any injury or accident which may occur.

Parent Signature: _________________________________Date: ____________

Memorial Day Chicken Dinner: We need at least one representative from each family to help with the dinners. My family prefers: set up___ tear down___ early shift pit___ late shift pit___ early shift wrap___l ate shift wrap___ drive-thru____ shelter house___

REGISTRATION DAY: February 28th, 2021

If you cannot make it to the registration day, you may print out the form @ www.bucklandrec.com and mail them to 17066 Buckland River Rd., Wapakoneta, OH 45895.

DEADLINE FOR SIGNUPS: March 1st, 2022

Buckland Recreation
Medical History, Informed Consent & Release Form

I hereby give permission for (player)______________________________ to participate in the Buckland Recreation Program during the ____________season. Further, I authorize the coaching staff to provide emergency medical treatment of an injury to or illness of 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 (player)____________________________.

This authorization is only granted if I cannot be contacted and a reasonable effort has been made to do so.

Parent/Guardian:________________________________________________

Home Phone:____________________________ Cell Phone:_______________

Address:______________________________________________________

Family Physician:_________________________Phone:___________________

Child’s Physician__________________________Phone:__________________

Child’s Dentist___________________________Phone:__________________

Medicines child currently taking;____________________________________.

Date of last tetanus shot:_____________ Insurance Company______________

Policy or Plan ID#:______________________________________________

Subscriber's name:_______________________Relationship to player________

Subscriber's Employer:____________________Work Phone:______________

My child and I are aware that participating in t-ball, baseball or softball is a potentially hazardous activity. I understand that my child is not covered by any insurance plan through the Buckland Recreation and do hereby waive, release, absolve, indemnify and agree to hold harmless the Buckland Recreation and any of its board members, 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, special events or any Buckland Recreation associated activity. I assume all risks, including but not limited to falls and contact with other participants, being hit with the ball or bat, the effects of weather, traffic and other reasonable risk conditions associated with athletics. All such risks are known and understood by me.

Parents Signature: __________________________________ Date: _______