Player Registration

PLAYER REGISTRATION FORM

Fill out the form below to register your child in the 2021 Havana Youth Baseball/Softball League. All fields are required.

    League:

    Division:

    Shirt size:

    Player Name:

    Parent/Guardian Name(s):

    Street Address:

    City:
    Zip:

    Primary Phone #:

    Email Address:

    Emergency Contact:

    Telephone:

    Do you want to Coach (Yes or No):

    PLAYER CONSENT & RELEASE FOR MEDICAL TREATMENT:

    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 registrant's 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 the life, limb, or well-being of the above-named player.

    List any special needs or allergies:

    List Medication(s):

    Personal Physician:

    Physician Phone:

    Insurance Carrier:

    Photo Release

    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.