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Batavia Community Recreation League

Athletic Team Fee 2024

Official Website
513-732-3868

Participant Information

First Name

Last Name

Gender

Date of Birth (mm/dd/yyyy)

School Information

School Attending

Grade Missing a grade?

Parent Information

Parents Name

Phone Number

Address 1

Address 2

City

State

Zip Code

Medical Information

In the event reasonable attemts to contact me with the information provided above failes, I give consent for the administration of any treatment deemed necessary by the doctor and dentist below, or to the hospital below (or a reasonably accessible hospital). This authorization does not cover major surgery unless two licensed physicians or dentist concur in the necessity for such surgery prior to its performance.

Medical Doctor Information

Doctor or Practice Name

Doctor or Practice Phone Number

Dentist Information

Dentist or Practice Name

Dentist or Practice Phone Number

Preferred Hospital

Preferred Hospital Name

Preferred Hospital Phone Number

Additional Medical Notes

Allergies, medicines, etc... (if your child has a medical condition that requires special attention, a parent is required to be at all practices and games)

General Consent and Release of Liability

I give permission for the registered child to participate in the Batavia Community Recreational League. I understand that there is no insurance coverage for any injuries sustained as a result of participation in this program and I also agree to hold blameless the Batavia Community Recreation League, its coaches, assistant coaches, and sponsors for any injuries sustained as a result of participation in this program.