בס"ד
Congregation Ahavas Yisroel of Kew Gardens Hills
Focused on Torah, Tefillah, Gemilus Chasadim and Eretz Yisroel
                            Rabbi Herschel Welcher - Marah D’Asrah
2011 Ahavas Yisroel Baseball Registration and Liability Waiver Forms

[Please note that registration is subject to team availability.  While all requests for registration and/or team placement will be considered, neither registration nor placement on any team is guaranteed.  Parents are urged to participate in managing/coaching duties.   Please indicate whether you are available to manage, coach or assist.  In the event any team does not have a manager/coach, that team will not be fielded.]

Players are expected to attend ALL games, be dressed in full uniform each week (official AY jersey, AY cap and gray pants, and wear an athletic supporter with cup).

Last name:		     	 			Child’s First name:				
Father’s name:					Birth date: 					
Mother’s name:				

Phone (home):							
(day):							E-mail: 					
(father’s cell):					
(mother’s cell):					

Address: 						Yeshiva: 					
							Grade:						

Jersey # (list current number if you already have a jersey, otherwise list three preferences):			

Have you played for AY previously (Y/N) 		
Friends on team (list three): 																						
Seudas HaBar Mitzvah/Graduation dates (grades 7 & 8): 					

Member (circle one):		YES				Fee:		$100.00
					NO				Fee:		$125.00

Uniform Size (includes last name on back and number):
[Anyone purchasing the new jersey should leave the size blank.  A time will be schedule for fittings when registration has concluded and samples are available].  
•	Jersey				$27.50
•	Pants				$17.50 
•	Hat - Regular			$  5.00
•	Hat - Embroidered		$  9.00
•	Sweatshirt			$18.00

Total Uniform Cost:			
								Total Due:			
Payment Type:
Check 	Cash 	Bill (members only)	Amount Paid: 			

CONSENT, WAIVER, RELEASE OF LIABILITY
AND ASSUMPTION OF RISK ACKNOWLEDGMENT FORM

I, (Parent/Legal Guardian_____________________________, hereby state that I am the Parent or Legal Guardian for (please print): 

Name______________________________________, Date of Birth_____/_____/_____;

Name______________________________________, Date of Birth_____/_____/_____;

Name______________________________________, Date of Birth_____/_____/_____;

Name______________________________________, Date of Birth_____/_____/_____;

I hereby grant permission for the above-named child(ren) to participate in Congregation Ahavas Yisroel’s (“CAY”) baseball program affiliated with Jewish Community Little League (“JCLL”) for the 2011 season.

In addition, I hereby grant CAY and its agents express permission and consent, in my absence, to authorize medical treatment for the above-named child(ren) should he/they sustain any injury arising from their participation in any CAY/JCLL baseball activity or as a result of medical conditions known or unknown including, but not limited to, notification for and treatment by emergency services as well as transportation to and treatment at an emergency facility.

I further knowingly, voluntarily and expressly assume full responsibility for any and all inherent and natural risks associated with the danger of bodily injury arising from or related to any CAY/JCLL baseball activity or as a result of any medical condition known or unknown.

I further knowingly, voluntarily and expressly release and hold harmless CAY/JCLL from all claims and/or demands including, but not limited to, personal injury or property damage, regardless of whether such was caused by the negligence of CAY/JCLL or its agents, which I may otherwise have against CAY and JCLL or its agents.

________________________________			________________________
          Parent/Guardian (Print)						       Date

________________________________
          Parent/Guardian (Signature)