LBSA

Last Name First Name Male Female

Date of Birth: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992

Years of Experience: 1 2 3 4 5 6 7 8 9 10 11 12+

School District :

CONTACT IFORMATION

Address

City State Zip Code

Home Phone Emergency Phone

Email Address

Parent / Guardian (First Name) Parent / Guardian (Last Name)

Parent / Guardian (First Name) Parent / Guardian (Last Name)

ADDITIONAL NOTES FOR THE LBSA BOARD

Please be advised that by submitting this application you agree that the Lebanon Baseball/Softball Association, Inc. will not be responsible for any injuries, damages, or personal losses resulting from participation in this program or as a spectator. I, the undersigned parent or legal guardian of the above child, agree to pay a NON‐REFUNDABLE fee to the Lebanon Baseball/Softball Association, Inc. for the enrollment of said minor.

I agree to abide by the Lebanon Baseball/Softball Association Code of Conduct. I also agree to insure that the above child abides by the Lebanon Baseball & Softball Association Code of Conduct. I understand that failure to abide by the Lebanon Baseball & Softball Association Code of Conduct can result in disciplinary action being taken up to and including removal from the league and being banned from the parks.