Access Leisure Registration Form - Department of Parks and Recreation

River Cats Independence Field Youth Baseball League Registration

Athlete’s Name:_____________________________
Age:______ Birthday: ___/___/___
Parent(s)/ Guardian(s) Name(s): ____________________________________
Address: __________________________________________
City: ___________________ State: ___ Zip:_______
Phone: ________________ Cell: ______________
E-mail Address: __________________________________________

Type of Mobility
(If athlete will be using more than one device, please bring all devices that will be used):
Wheelchair: [ ] Manual [ ] Power - voltage:_____
Other Devices: [ ] Braces/Crutches [ ] Walkers [ ] Uses No Devices
Diagnosis and Disability: _________________________________________________________

T-Shirt Size
Youth Sizes: [ ] Small [ ] Medium [ ] Large Adult Sizes: [ ] Small [ ] Medium [ ] Large [ ]XL [ ]XXL
Fees
Registration fee is $40 per league. (make checks payable to ”City Of Sacramento”) Total enclosed: $________
*Scholarships available-call for information

FOR OFFICE USE ONLY: [ ]Cash [ ]Check #______ Date_______
Received by: ___________

Liability Release: The undersigned, in consideration of the acceptance of this entry, I hereby waive, release and indemnify the City of Sacramento, Access Leisure, sponsors, staff, and volunteers from any and all liability for injuries and/or expenses incurred by myself at the River Cats Independence Field Baseball League. In case of accident arising out of the said activity, medical assistance may be administered to the registrant of this activity. Media Release: I specifically grant permission to the River Cats Independence Field Baseball League to use my likeness, voice and words in television, radio, newspapers, films, magazines, and media of any form not heretofore described to further the aims of the River Cats Independence Field.

_____________________________________________
Signature of athlete, or guardian if under 18 yrs/ old

________________
Date Signed

Return to: Steve Hornsey, 3291 Truxel Rd, #26 Sacramento, CA 95833.

YES! I am interested in participating in the
25th Annual A.C.T. Games, open to
youth ages 3 to 18 with physical
disabilities. Please add me to the
mailing list. Please fill out and return EVEN IF
You have participated in the past!

Athlete’s Name:_________________________
Age:______ Birthday: ___/___/___ [ ]M [ ]F

Address:
______________________________________
City: _______________ State: ___ Zip:_______
Phone: ______________ Cell: _____________
E-mail Address:
______________________________________

Training Sessions (must attend at least one):
Training Session #1- Saturday, March 20
from 12-4pm (Sac State Yosemite Hall Rm. 183)
[ ] YES, I will attend [ ] NO, I will not attend Training Session #2- Saturday, April 3 from 9:30-11:30am (Inderkum HS track)
[ ] YES, I will attend [ ] NO, I will not attend Training Session #3- Saturday, April 10 from 9:30-11:30am (Inderkum HS track)
[ ] YES, I will attend [ ] NO, I will not attend

Return to:
Steve Hornsey, ACT Games, 3291 Truxel Rd, #26
Sacramento, CA 95833
Call 808-2340 or email
shornsey@cityofsacramento.org with questions.

_____________________________________________
Signature of athlete, or guardian if under 18 yrs/ old

________________
Date Signed

As January 2009, a yearly $10.00 service fee for the Access Leisure Ink quarterly newsletter will be charged to people who are requesting to receive the newsletter through the mail.

Name: _______________________________________________

Phone: _____________________________

Mailing Address: _____________________________________________

City: ____________________    Zip ________________

Please check one box below:
[    ] Please keep me on the US Mailing list.
I have included a check of $10.00 for fees.Make checks payable to: City of Sacramento
Mail to: Access Leisure INK Newsletter Fee, 3291 Truxel Rd, #26 Sacramento, CA 95833
[     ] Please remove me from the Mailing List.
** To receive the quarterly newsletter via email Steve Hornsey at shornsey@cityofsacramento.org.

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