2010 Ravenna Fall Baseball League

Team Roster, Birth Date Confirmation

and Insurance Waiver Form

Team Name:                                                            Age Group:                                        

Manager:                                                                 Phone:                                                

Player's Name                            Birth Date                  Parent's Signature*

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*By affixing the above signature, I do hereby release Ravenna Hot Stove Baseball and all persons affiliated with the Ravenna Fall Baseball League, including, but not limited to, the City of Ravenna and/or Ravenna Township from any liability as a result of my child's participation. I understand that Ravenna Hot Stove Baseball will not provide any coverage, medical or otherwise, and the expense of any injury will be born by me or the team's sponsoring league's insurance. Furthermore, by signing this form, I am guaranteeing that the birth date listed for my child is indeed accurate and true.

Fill in all info requested and send, with fee, (Check made payable to Ravenna Hot Stove) to: Ravenna Fall Ball, c/o Lonnie Stacy, 6292 Suelynn Dr., Ravenna, Ohio 44266