Late Registration Late registration for HYL 2021 Coed T-Ball. There is no fee for T-Ball. Shirts and caps are sponsored by Josh Peterson at State Farm Insurance in Havana. Due to late registration your child’s shirt may not be ready to start the season. Players Name: Birthdate: Shirt Size Parent(s)/Guardian name(s) Parent(s)/Guardian email address Street Address City, State, Zip (HYL Coed TBall is for District 126 Students ONLY) Primary Phone Number Emergency Contact Emergency Phone Number Do you want to Coach (or help)? YesNo List any special needs or allergies Medication Personal Physician Physician's Phone Insurance Carrier PLAYER CONSENT & RELEASE FOR MEDICAL TREATMENT: Check this box if you accept the terms below I, the parent/guardian of the registrant, agree that the registrant & I will abide by the rules of the Havana Youth League (HYL), recognizing the possibility of physical injury associated with playing or as a spectator and in consideration of the HYL, accepting the registrant for its programs and activities, I hereby release, discharge and/or indemnify the HYL, its affiliated organization and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for the activities, against any claim by or on behalf of the registrant/other related parties as a result of the registrants participation in the program. As the parent or legal guardian of the above named player, I hereby give any consent for the emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb or well-being of the above named player. Check this box if you accept the terms below Photo Release: I hereby grant the Havana Youth League and to its Governing Board and other designees the right to photograph my child, named above and use the photos and other digital reproductions of his/her physical likeness for publication process, whether electronic, print, digital or electronic publishing via the internet. This release will be limited to the Havana Youth League website. I certify that I am a custodial parent and have the aforementioned right to assign.