GREENVILLE GIRLS SOFTBALL ASSOCIATION, INC.2013 PLAYERS APPLICATIONOpen to all girls in Darke County

GGSAONLINE.COMTO PARTICIPANT:A player must NOT have attained the age of 19, prior to January 1, 2013. A T-Ball player must be at least age 4 on January 1, 2013.Please mail application to Greenville Girls Softball Association, PO Box 1141, Greenville, OH 45331 by March 23, 2013 toguarantee placement on a team. LATE SIGN UP DATES @STEBBINS FIELD 3/9. 3/16. & 3/23. 12PM to 2:30PM

*Note: Players who sign up after uniforms are ordered and delivered will be charged $10 for printer setup fees.

NAME. .BIRTH DATE. AGE GRADE _

ADDRESS PHONE _

EMAILADDRESS _Check all that apply:__ 1 played ball in Greenville or a like program last year. Team or Coach Name: ___ I did NOT participate last year, but have played in previous year(s). List last year ofparticipation. ___ 1 participated on an All-Star Team last year. 1was on the (8U, IOU, 12U, 14U, 16U, 18U)__ I have a sister(s) participating in softball this year and would like 1not like to be on the same team (if in the same league).

Name: Age: _Name: Age: _

What position did you play most often? _

LEAGUE INFORMATION: Any player can play in BOTH slow pitch AND fast pitch.the Gameday Ticket or Peelers fundraiser goals to be eligible to play.Age on January 1, 2013 ______ T-Ball (age 4-6)____ .Munchkin (ages 7-8)_____ Minor (ages 9-10)___ --'Junior (11-13)____ Senior (14-18)

You only have to pay ONE time OR meet

Fast Pitch3Td & 4thGrade-----5th& 6thGrade

-----7ili & 8thGradeFast pitch teams will play against surrounding towns.

NO FASTPITCH APLICATIONS AFTER 3/17TO THE PARENT:Our summer program is growing through the help of a lot of people like yourself. If you are willing to help, please indicate so byplacing your name( s) on the line after the position of interest. (Please keep in mind that coaches are needed to make our programpossible, however, signing up for a coaches position does not guarantee you a team. The League Coordinator will notify all coaches.)

COACH ASSISTANT COACH _TEAM PARENT: ------------------------Did you coach/assist last year? --.,-- _Are there any facts concerning your daughter's health history including allergies, medications being taken regularly, or any physicalimpairment to which we should be alerted. Please List: _

If your daughter is wearing braces, we strongly SUGGEST that you contact your orthodontist to get an approved mouthpiece. Piercedearrings or any jewelry will not be allowed during any game. Rules will be followed in these circumstances.

I hereby certify that I am the parent/guardian of the above named girl and give my consent for her to participate in the GREENVILLEGIRLS SOFTBALL ASSOCIATION, INC., league. I further agree that 1 will be responsible for the maintenance and return allequipment assigned to the girls. I also agree to hold harmless the GREENVILLE GIRLS SOFTBALL ASSOCIATION, INC., anyOfficer or Trustee, team coach, assistant coach, or any and all volunteer helpers in the program, for any and all injuries, which may beincurred by the above named girl.

SIGNATUREOFPARENT/GUARDIAN _

Contacts:Bobby Roark (President) 621-7045Jeremy Kautz (Vice-President) 564-2377Tiffany Shaffer (Secretary) 548-3854Lindsey Beatty (Treasurer) 467-1527Stephanie Christman (Concession Manager) 423-7721Joe Osborne (Equipment Manager) 308-0503

Tracy Roark (Senior Coordinator) 423-8735Kayann Kretschmar (Junior Coordinator) 423-0385Heidi Klosterman (Minor Coordinator) 423-0665She1lie Walker (Munchkin Coordinator) 548-6171Amy Huecker (T-Ball Coordinator) 417-4005Shawn Shaffer (Fast Pitch Coordinator) 459-9187Eric Fellers (Tournament Director) 417-1560

VOLUNTEERS NEEDED FORFUNDRAISING. WEEKEND

TOURNAMENTS. ETC.

___ YES, I WOULD LIKE TO HELP

___ NO, I WILL NOT BE ABLE

PLEASE COMPLETE THE MEDICAL CONSENT FORM ON THE BACKSIDE OF THIS SHEET.

GREENVILLE GIRLS SOFTBALL ASSOCIATION, INC.MEDICAL CONSENT FORM

ATHLETE: _

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examinationsfor the above named player. In the event of serious illness the need for major surgery, or significant accidental injury, I understandthat an attempt will be made by the attending physician to contact me in the most expeditious way possible. If said physician is notable to communicate with me, the treatment necessary for the best interest of the above named athlete may be given.

In the event that an emergency arises during the practice session, an effort will be made to contact the parents or guardians as soon aspossible. Permission is also granted to the coach or Area Rescue to provide the needed emergency treatment to the athlete prior to heradmission to the medical facilities.

Signature of Parent or Guardian Date

ATHLETE AGE DATEOFBIRTH _

ADDRESS PHONE# _

FATHER:Name: _

Employer: Phone:-------------~ ----------Phone: (Cell) (Home) _

MOTHER:Name:-------------------------Employer: -'Phone: _

Phone: (Cell) (Horne) _

HEALTHINS: ,DENTALINS. _

FAMILY PHYSICIAN: ------'PHONE: _

ALTERNATE PHYSICIAN: ,PHONE: _

DENTIST: ,PHONE: _

PAST MAJOR ILLNESS OR INJURIES (if any): _

LIST ANY ALLERGIES: _

LIST ANY REGULAR MEDICATIONS THAT THE ATHLETE TAKES: _

IF PARENTS CAN NOT BE REACHED IN AN EMERGENCY WHO SHOULD BE CONTACTED?

Name: Relationship to Athlete: _

Phone#: _