8/3/2019 Ryba 2012 Signup Form

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Rohrerstown Youth Baseball Association

2012 Spring Baseball Registration

Registration is open to all youths residing in the Hempfield School District between the ages of 5 and 14.Registration is Dec. 15 to Feb. 5. Late registrations will be accepted with a $25 late fee if space is available.

Team Divisions

Pony 8U 10U 12U 14U

Age 5-7 Age 7-8 Age 9-10 Age 11-12 Age 13-14

Age Requirements

Cutoff date is 4/30. Players reaching age 9, 11, 13, or 15 before 4/30 MUST move up to the next level.

Registration Fees

Pony Division - $75 8U - $100 All other Divisions - $140 Late Fee - $25

In order to make Rohrerstown Youth Baseball a success, we ask that you volunteer in any way that you can.See our web site for information at rohrerstown.weebly.com, or visit us on Facebook.

Please complete and detach the following form: (please print)---------------------------------------------------------------------------------------------------------------------Player Name: ________________________  Date of Birth: ____________________ Address: _____________________________________________ 

_____________________________________________ Home Phone #: __________________ Email Address: ________________________________ Age Group: ________________________  Last Year: ______________________________ Uniform size (circle one): Youth S M L

Adult S M L XLParents/Guardians Volunteering for:

Head Coach ________ Assistant Coach_______ Corporate Sponsor________ 

* RYBA reserves the right to require a background check on all coachesEmergency Contact Information:

 Name: ___________________________ Phone Number: __________________ Physician: ________________________ Phone Number: __________________ 

I acknowledge my understanding that Rohrerstown Youth Baseball Association (RYBA) only provides excess secondary insurance coverage for participants andcoaches. As a parent or guardian, I agree that my incurred expenses including those for sickness, accidents, and/ or injury must first be submitted to and consideredfor payment by a primary insurance provider. Following the determination of my primary insurance provider, the RYBA may consider a claim for any unpaid

 portions, excluding any amount that is applied to any deductible of my plan. Further, I understand the RYBA will not consider claims resulting from failure toremain within a provider network established by the primary carrier. I acknowledge that my child does not have any health limitations to prevent his or her 

 participation in this sport. At no time will I, or a member of my family, hold the RYBA, its officers, coaches, or officials, liable for any accident, injury, or resultingmedical problem or expense. My child has my permission to participate in the RYBA baseball program and will abide by its rules and regulations.

Parent/Guardian Name (print)_________________________ Date: ___________ 

Parent/Guardian Signature: ___________________________________________ 

Please make checks payable to Rohrerstown Youth Baseball Association

Mail to: RYBA

2148 Embassy Drive

Lancaster, PA 17603