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Online Youth Recreation League Registration Form
2018 - 2019 Boys League Registration Form

General Information:
Mailing Address
Street 1: *
Street 2:
City: *
State: * Ohio
ZIP Code: *
Primary Email Address
Email Address: *
Primary Phone
Phone Number: *
Contact Information:
Mother
Full Name:
Home Phone:
Cell Phone:
Email Address:
Father
Full Name:
Home Phone:
Cell Phone:
Email Address:
I would be willing to assist in the following position(s):




Your league director will contact you with further information on how to submit a coaches application and background check details.
Emergency Information:
Preferred Doctor: *
Preferred Hospital: *
Preferred Dentist: *
Participant Information:
Saved Participants:
No Participants have been Added. Click the Button Below to Add a Player
Waivers and Acknowledgements:
NOTICE!  Prior to submitting this form, you must read the following waivers and acknowledgements. Check of the box to the left of each section before continuing. Doing so verifies you have read and understand the statements below.
Waiver of Liability
We, the Parent and/or Guardian(s) of the players listed above acknowledge, understand, and agree that our child will be participating in physical activity and exercise that potentially involves risk of serious injury, harm, permanent disability, and/or death. We specifically understand that our child may be exposed to risks of harm or injury as a result of his/her own involvement, actions, inactions, and/or negligence and/or as a result of the actions, inactions and/or negligence of other participants, playing rules, and/or the conditions of the premises or equipment utilized. In consideration of the JYBA’s acceptance of our child for participation in the events, programs, and/or activities of the JYBA, we hereby fully release and forever discharge the Jackson Local School District, the JYBA, its officers, agents, coaches, officials, directors, managers, volunteers, and/or the sponsors and/or the owners and lessees of any premises utilized to conduct the program events from and for any and all liability, including but not limited to, any claim, demands, expenses (including medical bills), damages on account of any injury, death, and/or damage to person or property caused or alleged to have been caused in whole or in part by the actions or omissions of Jackson Local Schools or the JYBA. We agree to indemnify and save harmless the Jackson Local School District and the JYBA from all claims or demands of every kind or character including, but not limited to, rights of subrogation. We will provide indemnification and cost of defense to the Jackson Local School District and JYBA for any future action that may be brought by any person and/or entity which may be asserted by reason of said injuries and/or damages or the effects or consequence thereof. This Release is expressly intended to cover and include all claims past, present, or future which can be asserted by us or on behalf of our child.
Emergency Medical Attention
In the event that reasonable attempts to contact me have been unsuccessful, we give our consent for the administration of any emergency treatment deemed necessary by a licensed physician or dentist in the event that the preferred practitioner designated above is not available; and to transfer my child to the preferred hospital if and/or when reasonably accessible. In the event of life threatening injuries requiring major surgery the medical opinions of two other licensed physicians or dentists, concurring in the necessity of such surgery, must be obtained before the surgery is performed.