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.

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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