Chesterfield Senior Softball Registration Form

CSSA 2022 Registration Form
Deadline March 31, 2022

Complete this form, print it, and mail your completed Registration form with your check to :
Chesterfield Senior Softball Association
PO Box 2713
Chesterfield VA 23832

Men's League
Thursday Night $70.00
Spring Co-ed League (Draft) Monday Night $70.00
Fall Co-ed League (Draft) Monday Night $70.00
Our leagues play from April through August each year. Games start the week of April 25, 2022
(All dates are subject to change according to the Governor's directives for COVID-19)



Player Information

Name Home Phone
Date of Birth Mobile Phone
Home Address Email
City or County Zip Code
Shirt Size S M L XL 2XL Preferred Number
Emergency Contact Phone Number
Positions Played P C 1st 2nd 3rd SS OF Preferred Position #1 _________ #2 _________ #3 _________

Men's League

Posse Young Virginians Players Hog Polers
I am registering with a new team Team Name:
I am a new player and need a team

Coed League (Draft)

I would like to play with Relationship to player
Team assignments: Priority assignments will be given to family members or first year players with individuals who brought them into the league.
Only (1) family/friend assignment per player

Leadership Opportunities

Leadership/Participation: Please indicate if you may be willing to serve CSSA in some capacity: (Checking the box only obligates you to discuss the possibilities with a board member.)
Team Manager Board Member Tournament Committee
Rules Committee Fall Ball Committee Other / Not sure

Registration Fees

Men's League (50+) $70 $
Coed League (Men 50+; Women 40+) $70 $
Non-Resident Fee $15 $
Late Fee (after March 31, 2022) $10 $
Total $

***Sponsors: If you want to sponsor or know of a company that may want to be a team sponsor or otherwise donate to our league, please contact Jeff Davis at 804-441-1322.

Player Release and Waiver of Responsibility

Every player must sign this form to be allowed to play.


PLEASE READ BEFORE ACKNOWLEDGING:

In consideration of the acceptance of my application for registration in the Chesterfield Senior Softball Association (CSSA), I have and do hereby assume all risks connected to the Chesterfield Senior Softball Association activities. I hereby for myself, my heirs, executors, administrators, and assigns, waive and release and discharge any and all rights and claims for damages and/or losses which I may have against the Chesterfield Senior Softball Association, its officers, board members and/or agents, for any and all activities connected with the Chesterfield Senior Softball Association. I understand the meaning of this agreement and my signature hereon indicates that it is a voluntary act on my part.

In consideration of being allowed to participate in any way in the CHESTERFIELD SENIOR SOFTBALL ASSOCIATION, Leagues, Tournaments, and all sports programs whether involving team or individual sports and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

  • I am 18 years of age or over, and I desire to participate in the CHESTERFIELD SENIOR SOFTBALL ASSOCATION (CSSA) adult sports Activities.
  • The risk of injury from the activities involved in the program is significant, including the potential for permanent paralysis or death, and while particular rules, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist.
  • The risk to have direct or indirect contact with individuals who have been exposed to and/or diagnosed with one or more communicable diseases, including but not limited to COVID-19 or other medical conditions, diseases, or maladies, and/or any mutation or variation thereof, does exist and it is impossible to eliminate the risk that I could become infected through contact with or close proximity to an individual with a communicable disease;

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others and assume full responsibility for my participation.

I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual, significant hazard during my presence or participation, I will remove myself from participation and bring such hazard to the attention of the nearest official immediately.

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS THE CHESTERFIELD SENIOR SOFTBALL ASSOCATION (CSSA) and its officers, officials, agents and/or employees, other participants, sponsoring agencies, directors, sponsors, advertisers, and, if applicable, owners and lessors of the premises used to conduct the event (collectively, the "Releasees"), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY, HOLD HARMLESS AGREEMENT, AND ASSUMPTION OF RISK AGREEMENT AND THAT IT IS A LEGALLY BINDING CONTRACT BETWEEN CHESTERFIELD SENIOR SOFTBALL ASSOCATION (CSSA) AND ME. I FURTHER UNDERSTAND THAT THIS RELEASE IS BINDING ON MY HEIRS OR ANYONE MAKING A CLAIM. I SIGN OF MY OWN FREE WILL

Player Name (Please Print )
Cell Phone Number
 
_________________________________________
Signature
__________________________________________
Date




For office use only

Check # ______________ Balance ______________
Rec'd by ______________ Cash ______________
Date Rec'd ______________ Total Paid ______________