Applicant's Information:

Umpires Name:         

          Date of Birth (MM/DD/YYYY):   

Street:            

City:     

State:    

          Zip:       

Home Phone:     Cell Phone:     Email:

 

       

          Parent's Information:

Mom's Name:         

          Mom's Phone Number:  

Mom's Email:             

 

Dad's Name:              

          Dad's Phone Number:  

Dad's Email:             

 

          General Health Information:    

           Is the applicant covered by a health insurance plan (Y/N)   Yes      No

           If YES, please complete the information below:   

           Type: HMO PPO/POSKaiser State Plan  

           Name of Primary Insurance Carrier:     

           Name of Primary Care Physician:          

           Primary Care Physician’s Phone:           

           Does the applicant have any health conditions which could be impacted by his/her participation as a youth umpire?

            Yes      No

           If YES, please explain:   

           Does the applicant have any known allergies of which HAJBA or medical personnel should be aware?   

           Yes      No

           If YES, please list:  

        Experience:    

   

          Do you have previous HAJBA umpiring experience?    Yes      No 

   

          Have you attended any umpire training in the past?   Yes      No  

   

HAJBA requires all of their Youth Umpire applicants to attend (3) umpire training clinics. Two of these clinics will be held in a    classroom environment, and the third will be an On-Field Mechanics clinic. HAJBA also requires that each umpire obtain a          passing grade on an online test given at the conclusion of the second classroom clinic. The classroom umpire clinics are spread across two dates and potential umpires are required to attend both classroom clinics. The potential umpires will be made aware of the training session dates, and these dates will be posted on the calendar at www.howellbaseball.org.

The following materials will be used during the Umpire Classroom Clinics:

Official NFHS Baseball/Softball Rulebook

Umpire Survival Training – Baseball Rules Workbook by Mark Swiss

HAJBA Baseball/Softball Rulebook

If you attended the HAJBA Umpire clinics last Season, and you still have some/all of the below materials, you will not need to purchase them again.

If you are new to the Umpire program, or no longer have your materials from last season, you will need to purchase them.

The below costs are what HAJBA pays for each item. There is no markup for the items.

Please indicate below which items you need to have ordered.

There will also be an $8 per umpire charge to cover the cost of the building rentals to run the classroom clinics.

We will order the Item(s) you indicate below and have them available to you at the first classroom clinic.

You will need to bring payment for the materials and building rental to the first classroom clinic.

These are the costs for each item: 

Official NFHS Baseball/Softball Rulebook -  $8.00 - Do you need one? (Yes or No)

Umpire Survival Training – Baseball Rules Workbook by Mark Swiss – $12.00 - Do you need one? (Yes or No) 

HAJBA Baseball/Softball Rulebook -  $3.00 - Do you need one? (Yes or No) 

FYI, the 2009 version of the NFHS Rulebook can be used for these classroom clinics. You do not need to purchase a 2010 version, unless you want to.

Once you have completed your training clinics, and obtained a passing grade on the online test, you will be provided with an umpire shirt, hat, clicker and plate brush. The cost of these items to you will be $15. Once purchased, these items will be yours to keep.

We will get a list of which of the above items (umpire shirt, hat, clicker, brush) you need after you pass the online test.

Notice to Applicant:

HAJBA considers all umpires to be independent contractors. This means that HAJBA will not hold back any amounts from the money owed to you in order to pay taxes. You will be paid by cash. In order to be paid you will need to fill out an umpire game report, which HAJBA will provide to you. HAJBA cannot pay you until your umpire game report is filled out. The amount will be based on the division of the game you work, and whether you work alone or with a partner. You will not be paid for games you do not work.    

As part of your responsibilities, you will be required to use certain safety equipment during the season. Examples of this equipment include shin protectors, chest protector and face mask. This equipment will be located in the concession stand at each of the field locations. Thirty minutes prior to a game you are scheduled to work, you should go to the concession stand, remove the equipment from the designated area in the concession stand, and put it on. Once you are equipped, you should proceed to the designated field you are scheduled to work on. You should arrive at this field, dressed and ready to go, fifteen minutes prior to the game time.  Once the game is completed, you are to return to the concession stand and place your safety equipment back in its designated area. Once this is done, you will give your completed “Umpire Game Report” to the designated Umpire supervisor in the concession stand. They will confirm that your equipment has been returned, and pay you for your game. You can also choose to purchase this safety equipment on your own through an authorized dealer. Regardless of where you get the equipment from, the equipment used by you should be in good condition.   

In the event that you are unable to umpire a particular game that you are scheduled to work, you agree to attempt to contact other HAJBA qualified umpires to fill in for you in your absence. In the event you are not able to find a replacement, you agree to contact the League Commissioner as far in advance as possible to make them aware of your inability to work the game. Failure to show up at two games that you are scheduled to work, without finding a replacement or contacting a commissioner, will result in the revocation of your privilege to work future HAJBA sponsored games.     

Please speak with your parent(s) about the above notice, and be sure you understand it before submitting this form.   

Applicant’s Acknowledgement:

In participating in the HAJBA Youth Umpire program I acknowledge that I am considered to be an independent contractor. I understand that HAJBA will pay me at the end of each game, provided I have completed an Umpire Game report. The amount will be based on the pay scale I have been given for the division game I have worked. I realize that HAJBA will not withhold taxes from the amount due to me. If I owe taxes, I know that I will have to pay them, as I am not an actual employee of HAJBA.

   Type YES in this box to acknowledge that you read and understand the information above

Parent's Acknowledgement:

I grant permission for my child to participate in the HAJBA youth umpire program through the conclusion of the Spring/Fall 2010 Baseball/Softball season.  I know that participation in any sports-related activity, such as the umpiring of Baseball/Softball games can result in serious injuries to my child. I approve of my child's participation and will not hold the Howell Area Junior Baseball Association, Incorporated, (HAJBA) or any of its representatives responsible in case of accident or injury. Furthermore, I hereby give permission for any and all medical attention necessary to be administered to my child in the event of any accident, injury, sickness, etc. under the direction of the HAJBA staff. This agreement and release is effective for the time during which my child is participating in the HAJBA Umpire program including traveling to and from such activities. I also hereby assume the responsibility for payment of any such treatment. Protective equipment does not prevent all injuries to umpires.  In case of an emergency medical situation or condition, if I am not available, I hereby authorize my child to be treated by a medical technician who is available.   

 Type YES in this box to acknowledge that you as the parent or Legal guardian have read and understand the information above

In the event of an emergency should HAJBA representatives or medical personnel not be able to reach me, please contact the following person:

Name:  

Relationship to applicant:       

Phone#:     

Please confirm all of the information provided above is true and click the Submit button

                                         Submission of this form indicates that  I agree to the terms stated above: