Registration – Family

*(denotes required field)

Player Name #1 *

Player #1 Birthdate: *

Player #1 Age *

Player #1 Shirt Size: *

(Please specify Youth or Adult size)

Player Name #2 *

Player #1 Birthdate: *

Player #2 Age *

Player #2 Shirt Size: *

(Please specify Youth or Adult size)

Player Name #3

Player #3 Birthdate:

Player #3 Age

Player #3 Shirt Size:

(Please specify Youth or Adult size)

Player Name #4

Player #4 Birthdate:

Player #4 Age

Player #4 Shirt Size:

(Please specify Youth or Adult size)

Living With:

Occupation - Father

Occupation - Mother

Email Address - Father

Email Address - Mother

Special Remarks

Father's Name *

Father's Phone #

Father's Full Address

Mother's Name *

Mother's Phone #

Mother's Full Address

Other Name

Other Phone #

Other Full Address

Helper Information - Check As Many As You Can:

Manager Coach Snack Bar Board of Directors Team Mom or Dad Sponsor a Team Field Maintainance Donate Items Monetary Donation Donate Service (Specify Below)

Service to be Donated:

Medical Release

Name of Player #1 *

Name of Player #2 *

Name of Player #3 (if applicable)

Name of Player #4 (if applicable)

Phone Number *

Full Address *

Family Doctor's Name & Phone Number

Relevant past Illness, Injuries, or Allergies (if any)

Insurance Company

Policy Number

Comments:

In my opinion, *

are physically able to participate in this USA Softball League and have my permission to do so. I Understand that participation in softball may result in serious injury to any of my/our participating children. Protective equipment does not prevent all injury to players. In case of emergency: If Family Physician cannot be reached, I hereby authorize the above named players to be treated by another physician who is available. Also, this USA League has authorization to take the player/s to the nearest facility for treatment. Signed, *

Signature

Relationship to player, and today's Date

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