2023 REP Participation Form (Ingersoll Minor Baseball )

Ingersoll Minor Baseball is hosting tryouts for REP Baseball starting January 16th. Please see website and/or Facebook for additional information. Please complete the participation form prior to coming to a tryout.

Registration form

Player Last Name ^*
Player First Name ^*
Gender ^*
Male Female
PLEASE PICK ONE

Date of Birth ^*

Open the calendar popup.

Email Address ^*

Example: [email protected]
Street Address ^*
Town ^*
Postal Code ^*
Division^*

Utilize 2022 Division Communication Sheet to match birth year to division
Rep^*
YESNO
Played in 2021 ^*
YES NO
Medical Conditions If Any

PARENT INFORMATION

PARENT #1 FULL NAME ^*
PARENT #1 PHONE NUMBER ^*
PARENT #2 FULL NAME
PARENT #2 PHONE NUMBER

USE OF EMAIL ID

USE OF EMAIL ID: The email id(s) provided above will be used for player and/or coach communication by IMBA and coaches throughout the baseball season. Please notify the IMBA Executive via the IMBA email address [email protected] to have an email id removed from the mail list.

ACKNOWLEDGE USE OF EMAIL^*
YESNO
ACKNOWLEDGE THE USE OF YOUR EMAIL ADDRESS FOR IMBA TO COMMUNICATE SEASON EVENTS TO

PARENT GUARDIAN CONSENT

Over the course of the baseball season, player names (including team lists) are included on the IMBA website, public IMBA displays and possibly newspaper publications. Additionally, throughout the baseball season, individual and team pictures and videos are taken at various IMBA events (and may be used beyond the current year). Your permission is requested to use your child's full name and photographs/videos

PERMISSION GRANTED ^*
YESNO

RELEASE AND DISCHARGE ACKNOWLEDGEMENT

RELEASE AND DISCHARGE (please read carefully) In consideration of accepting the above-mentioned person, I grant him/her permission to participate in the Ingersoll Minor Baseball program(s). For the same consideration, I hereby release and forever discharge Ingersoll Minor Baseball Inc. (IMBA), its Officers, Directors, Conveyors, Coaches, Umpires or other Officials and the Town of Ingersoll from all claims, demands, damages, actions or causes of action arising or to arise by and reason because of my son's/daughter's participation in any Ingersoll Minor Baseball program, in this or any successive years(s), including (but without limiting the generality of the foregoing) any and all dental and medical bills and further of and from all claims or demands whatsoever in law or in equity which I, my heirs, executors, administrators or assignors can, shall or may have by reason aforesaid.

RELEASE AGREED TO ^*

ROWANS LAW

ROWAN'S LAW: Rowan's Law (Concussion Safety), is mandatory for sports organizations to: ensure that athletes under 26 years of age,* parents of athletes under 18, coaches, team trainers and officials confirm every year that they have reviewed Ontario's Concussion Awareness Resources. This Form MUST be completed by all players, coaches and umpires. To find Rowan's Law on our website please go to our home page-links, Rowan's Law https://tinyurl.com/y4bjsnlf

I HAVE READ AND ACKNOWLEDGE ^*
YES

MEDICAL ATTENTION PERMISSION

All players will wear the uniform of IMBA, and will act in accordance with the Players and Parent Code of Conduct I hereby grant permission for my child to play in the Ingersoll Minor Baseball Association I understand that IMBA will not assume any responsibility for any injury that happens I further give permission for IMBA to take my child to the hospital in the event of an emergency

I ACKNOWLEDGE AND AGRE
YES

Human Validation

Check The Box ^*

2023 REP Participation Form (Ingersoll Minor Baseball )

Get Mobile!

Contact Us