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Affiliation Form

BaseBall Federation of India

Name/School/Club/Univ.
sex	MaleFemale
Birth Date	*
Age on 8/1/07
Address	*
Pin Code
City
State
Tel No.	*
Website Address
Email ID
Sports Achievements 1	* Compulsory
Sports Achievements 2
Contact Person
Contact Person Tel No.
Contact Person Email ID.
Name of one adult willing to volunteer to do one of the following:	Coach Assistant Coach Field crew Admin Help Referee Tournament Sponsorship
Medical Information
Does your child suffer from any health condition that coaches and or participants should be aware of?
Does your child take medication in certain emergencies?
Does your child suffer from any allergies?
Non-parent Emergency/Contact:
Please Select Your Country	Select Country India Others
Affiliation Fee for India	Rs. 5000/- For Individual Rs. 50000/- For Schools/Club Rs. 75000/- Colleges Rs. 100000/- For Universities
Affiliation Fee for Other Countries	$1000 For Individual $5000 For Schools/Club $5000 Colleges $5000 For Universities
Remarks
Acknowledgment and Authorization: I,the parent or gurdian of the player named above,do hereby give my permission in my absence for any necessary emergency medical treatment to be administered by a licensed physician. I also give my approval for his/her paricipation in all Cumberland Valley Youth Rugby Association activities and assume all such risks and hazards incidental to participation. I absolve,indemnify and agree to hold harmless CVYRA and its programs,sponsors,coaches,referees and other participant's from all such risks and hazards. I hereby grant CVYRA permission to use my child's image for educational and promotional purposes.

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