MOSSBLUFFSOFTBALLLEAGUE

2OI1RE,GISTRATIONINFORMATION
FOR UP TO DATE INFORMATION PLEASE VISIT OUR WEBSITE
www. m ossblu ffstu ff. com
againwe
The Moss Bluff SoftballLeaguewould like to welcomeyou to your Z0l I softballseason'Once
Pitch and Buddy Ball In
(Coed).
areoffering:T-Ball (Boys &Girls), 3l2Ball, CoachPitch,Slow or Fast
2 0 l l w e w i l l a l s oo f f e r l 9 a n d u n d e rc o - e dI n c r e d i b a l l
ALL REGISTRANTS MUST SHOW A COPY OF THE PLAYERS BIRTH CE,RTIFICATE.

ON-LINE REGISTRATION IS OPEI{

wlYw. m ossb lu ffs tu ff. com

ON.SITE REGISTRATION DATES

Saturdays: January29'handFebruary5th
Time: 9 AM to 2 PM
Location: OpenAir Pavilion

FEES $50.00-lChild $80.00-2Children

If registering more than 2 children, $ 80 plus $ 20 for each additional child

TRYSUTS oN SATURDAY, FE,BRUARY19.hAT SOFTBALL COMPLEX

(T IM ES A R E S U B JE C TTO C H A N GE )

516(3-2Ball):8am 718(CoachPitch):9am 9110(Slow& Fast):10am

S l o wp i r c h : l l l l 2 : l p m 1 38 . u p :2 p m FasPt i t c h : 1 1 1 1 2 : 3 p m 1 3& .u p :3 p m
- !
If thereis inclementweather,informationwill be postedon the webpage www.mossbluffstuff.com

*** ATTENTION PARE,NTS, COACHES AND UMPIRES :K'(*

Januaryl" is the birth datecut off forthe 20ll season.Therewill be N0 refundsafterFebruary28.2010.
All formerCoachesand Assistantsreturningmust reapplyfbr the position.Thereis a mandatory$20.00
fee fora backgroundcheckperformedbyMoss Bluff Parksand Recreation.If thereare not enough
registrantsper actualage group to substantiateleagueplay (3 or more teams),the leaguemay combine
closeage groupsor allow registrants to switch (slow pitch or fast pitch).

A n y q u e s t i o n cs a nb e s e n tv i a e - m a i lt o :
andy @mossbl u ffs tu ff. com

* Information regarding Buddy Ball, please contact Barbara Duplechin at 855-2276 *

THANK YOU FOR YOUR SUPPORT

 MOSSBLTJFFSOFTBALLLEAGUE,
2OITRE,GISTRATIOI\FORM
wwvv.m ossbl u ffstu ff. co m

PLAYER INFORMATION (PleasePrint) I eovD Girl

Player'sFull Name
Address
Dateof Birth A g eo n l l l l l l

PLAYER UNIFORM II\FORMATION

ShirtSize ShortSize
(Number
NumberPreference choiceis for the backof thejersey- NO PROMISES)
1"Choice 2"dChoice

AGE GROUP INFORMATION (if 9 or older please select either fast or slow rritch)

3 l 2 Ba l l (5/6 yrs) C oach P i tch (7/8 yrs)

E f - eat t (3 /4 y rs ) [ I

I e-lo I n-tz I l3&u I FastPitch I SlowPitch

I 1 9a n dU n d e rI n c r e d i b a(l l$ 3 0 )

New to MBSL in 201I I yes I no what J-eamdid you play for in 2010?

PRIN&{RY POINT OF CONTACT FOR THIS PLAYBR?

Name: PrimaryPhone

e-mail: Alt Phone

VOLUNTEER INFORMATION

in volunteeringfor any of the following:

Are you interested
E ioach tr Asst.Coach I TeamParentfl [Jmpire

is $200; I
in sponsoringa team(teamsponsorship
Are you interested Yes I Xo

WAIVER OF LIABILITY & DISCLAIMER

oftheabovenamedchildwhoisacandidateforapositionona
MossBluffsoftbalttear1,lrerebygive my approvalfor thischild'spafticipation in anyandall of
the activitiesof the Moss Bluff SoftballLeague,the organizers, sponsors, andthe superuisors
appointed by thern.In caseof injuryto my child.I hereby waive all claims againsttheorganizers,
sponsors, or any supervisors appointed by them. I likewiserelease from responsibility any person
tiansportingmy child to andfrom the activities.I will furnisha certified birth fbr the
certificate
above-named candidateuponrequestof the MossBluff SoftballLeague officials.

Parent/Guardian: Date:

FOR LEAGUE USE ONLY

A m ountR e c e i v e d : C a s h Check#/Amount
B C V er if i e d : ryn\r) # of Players
 MOSS BLUFF SOFTBALLLE,AGUE,
APPLICATION FOR COACHORASSISTANTCOACH
(PleasePrint)

Name: Playersname:

Address:

Phone:Home Cell:

Email address:

Shirtsize:

Age Groups(x one): BoysRookieT-Ball (3-4Yr.) GirlsRookieT-Ball (3-4Yr.)

3l2-Ball(5-6yr.) CoachPitch(7-8yr)

9-l0 11-12 13&up SlowPitch FastPitch

Whatpositionareyou requesting: Head Coach Coach

Assistant

If applyingfor HeadCoach.areYourequestinga certainassistant?

Coach'sPromise
a HeadCoachand/or
By signing below, I attestthat I understandthe responsibilitiesrequiredand time involved as_
AssistantCoach, I agreeto manageeachteamin thisieagueandfulfill thesecommitments, abidethe leaguebyJawsand
rules,aswell ascoiduct myself-ina sportsmanlike manner.I do promiseto the bestof my ability,to teachthe players
good sportsmanship andhigh moralstandards, while promotingthe techniques ofthe game As statedin Article VII'
-Section
5 of the niBsl, ty-laws, it is mandatory that ALL COACHES and ASSISTANT COACHES attend an
scheduledfor
Umpire Clinic, Each Coach and Assistant will umpire the bases,ifneeded. Coaches(Both Teams)
for the last
the first game of the day, are required to mark the playing fiekl. Coaches(Both Teams) scheduled
game ofthe day, are required to remove the basesand rake the fields'

Applicant'sSignature Date
and
There is a mandatory background checkrequired.The fee for this is $20.00to be paid to the league
completedhy Moss Bluff Parks and Recreation.

Cash Check
 GommunityCenterand PlaYground
District4 Ward 1

BackgroundScreeningForm

In connectionwithyourapplicationforcoaching,TheCommunity CenterandPlayground
of
District4 Ward 1 may a
obtain background screening on you from LexisNexisScreening
Solutionsas partof the process your
of considering candidacy as a coach.ln theevent
thatinformation inwholeor in
fromthereportis utilized partin makingan adverse decision,
we willprovideyouwitha copyof the report

By your signaturebelow,you herebyauthorizeus to obtaina backgroundscreeningin

orderto consideryou for a coachingposition.

A p p l i c a n tN
' sa m e .

OtherNamesUsed.

Address:
Applicant's

C i t y / S t a tleZ i p .

T e l e p h o nNeu m b e r :

Number:
SocialSecurity

DriversLicenseN u m b ear n dS t a t e :

Nameas appearson DriversLicense:

Dateof Birth:

NOTE:Dateof Birthinformation is usedONLYby LexisNexis ScreeningSolutionsfor

of identityand is not usedfor any
verification purpose by the Community Center and
playground. The informationobtained by thisreleaseformor criminalhistorycheckwill
not be releasedpursuantto the LouisianaPublicRecordsLaw (LSA-R.S.44: 1 et
seq.)There is a $20.00chargefor this service payable to the Community Center and
PfaygroundDistrict4 of Ward 1.

Signature.
Applicant's
 MOSSBLUFF SOFTBALLLEAGUE,
APPLICATIONFORUMPIRE
(Please
Print)

Name:

Address:

Phone: Other:

Age Groups (you pref-ened): 3l2-Rall(516) CoachPitch(7-8)

9-10 rr-12 13& up Slow Pitch FastPitch

[JmpiringExperience

Haveyou appliedfor or intend to be an Umpire for any other league/team?

Yes No If yes,,pleaseexplain

Umpire'sPromise
By signingbelow,I attestthat
'Umpire. I understand requiredandtime involvedasan
theresponsibilities
I agreeto fulfill thesecommitments,abidetheleaguebyJawsandrules,aswell as
conductmyselfin a sportsmanlike manner.I dopromiseto thebestof my ability,to teachthe
playersgoodsportsmanship andhighmoralstandards,while promotingthetechniques of the
game.

Applicant'ssignature Date

It is mandatorythat applicantsattendtwo UmpireClinics.Thereis a mandatorybackground

by MossBluff
checkrequired.The feefor this is $20.00to bepaidto the leagueand completed
ParksandRecreation.

Cash: Check#:
 MOSSBLUFF SOFTBALLLE,AGUE
1072BlackwoodCourt
LakeCharles,LA 70611
(TAX ID # 26-4131730)
www. m ossblu ffstu ff. com

To Whom It May Concern:

Moss Bluff Softball Leagueis respectfullyaskingfor team sponsorsin supportof the 2011 recreational
season.The cost is $200 per team. This coversthe team's shirtsand shorts. Your name/companyname
will be printed on the back ofthe shirt abovethe number.

All checksshouldbe madepayableto the Moss Bluff Softball League(MBSI,). If you haveany
questionspleasefeel free to contactme via e-mail at andy@mossbluffstuficom.

Any sponsorshipwill be greatly appreciatedand accepted.

Thank you,

Andy Lavin
President
Moss Bluff Softball

Sponsoror CompanyName:
(liame thatwill appearon the back of shirt)

ContactPerson

PhoneNumber

Nameof Teamyou wish to sponsor

or
Player'snameandagegroup
 MOSSBLUFF SOFTBALLLEAGUE
1072BlackwoodCourt
LAKE CHARLES,LA 70612
(TAX ID # 26-4131730)
www.mossbluffstuff.com

To Whom It May Concern:

Moss Bluffsoftball Leagueis respectfully askinglocal business/companies for advertisementsignsin support

'ih.
ofthe 2011 recreational,"uron. cost is $250 per sign. This coversthe sign and print Your name/company
namewill be printed on the sign and hung on the outfield fencing for the entire softball season.Following this
year you will only be chargeda renewalfee of $150 per sign.

A1l checksshouldbe madepayableto the Moss Bluff Softball League(MBSL). If you have any questrons
'
pleasefeel free to contactme by e-mail at andy@mossbluffstuff'com

Any sponsorshipwill be greatly appreciatedand accepted.

Thank you,

Andy Lavin
President
Moss Bluff SoftballLeacue

Sponsoror CompanyName

ContactPerson

PhoneNumber

Any SpecialRequeston sign

THANK YOIJ FORYOTJRSIJPPORT