Town of Champlain Youth Baseball/Softball Signups
"Baseball/Softball sign-ups are now open for Champlain and Rouses Point Deadline is April 14, 2025. If you have any questions reach out to Charlene Sample at recdept@townofchamplain.
CHAMPLAIN AND ROUSES POINT YOUTHCOMMISSION
2025 BASEBALL/SOFTBALL/TBALL REGISTRATIONFORM –
“ONE FORM PER CHILD”
PARTICIPANT’SNAME:___________________________________________________
AGE:_______________DOB:_______________GENDER (PleaseCircle): M or F
STREETADDRESS:______________________________________________________
TOWN/VILLAGEOF:_____________________________________________________
PARENT/GUARDIANNAME:_______________________________________________
EMAIL:________________________________________________________________
PHONENUMBER:_______________________________________________________
Name/Contact info if you are interested inCOACHING:_________________________________
Myson/daughter____________________________________________ has my permission toparticipate in the above program. I understand that the participation in sportsactivity involves rigorous physical activity and creates a risk of physicalinjury, as the parent or guardian of the above-named child, I assume that risk.I hereby consent to emergency transportation and treatment of my child in theevent of illness or injury. I further certify that my child named here in is ingood physical condition and has no pre-existing medical or physical conditionthat would endanger the health, safety, or welfare of my child should he or sheparticipate in youth commission sports activities. As the parent and/orguardian of the above-named child I hereby covenant and agree to the releaseand hold harmless to the extent permissible by law, the Town of Champlain andits employees from any and all liability, loss, damages, claims, or actions forbodily injury and/or property damages occurring by reason of the participationof my child in Youth Commission sports activities.
Signatureof Parent/Guardian:___________________________________________________
PrintName:____________________________________________ Date:_________________
Please return forms to your school or emailforms to recdept@townofchamplain.com by
APRIL 14th, 2025.
***FOR OFFICE USE ONLY
____TBALL (Born on/after 8/1/18) (Born on/before 7/31/20)
____GRASSHOPPER (Born on/after 8/1/15)(Born on/before7/31/18)
____PEEWEE (Born on/after 8/1/12)(Born on/before7/31/15)
____PONY (Born on/after 8/1/08)(Born on/before 7/31/12)
Revised March 17, 2025
