Oly south summer ball league

Age as of May 1, 2017: 4-5 Shetland, 7&8 Pinto and 9&10 Mustang, Bronco 11&12

6-Shetland Co-ed Modified Coach Pitch

Fees: Shetland $ 50, Pinto and Mustang $ 50, Bronco $55 $10 discount for additional children from the same family

Shetland Co-ed Modified $50
Players Name:______________________________DOB________ Male/Female Shirt Size: YS YM YL AS AM AL AXL

Circle League: (4-5) (7&8) (9&10) (11&12)

6 Modified

Address:____________________________e-mail:____________________________________

City:_______________________________

Father Name:________________________Phone:___________________________________

Mother Name:_______________________Phone:___________________________________

Are you willing to Coach? YES NO Shirt Size ________ Assistant Coach? YES NO Shirt Size _________

Payment: CASH_______ Check #_______ Credit Card________ GO TO: www.atlantaillinois.org

WAIVER

This waiver must be signed by the parent or guardian to have a valid registration. There is no insurance provided. I, the parent or guardian of the Player Named, agree that the City of Atlanta and all individuals participating in the program in any capacity will not be liable for any cause of actions, claims, and injuries arising out of participation of the player in the program. I hereby release all said individuals from such claims and liabilities. The undersigned acknowledges that in all sports there are certain risks of injuries and that all participants participate at their own risk. I, as legal parent or guardian, hereby consent under the above mentioned conditions.

Signature:______________________________ Date:_________________________

PAYMENT

ONLINE PAYMENT

Email completed form to: Olysouthsummerballleague@gmail.com

Payments can be made at: www.atlantaillinois.org

MAIL PAYMENT and Completed Form

Atlanta City Hall

107 NE First Street

PO Box 385