Registration – Single

*(denotes required field)

Player Name *

Birthdate *

Age *

Shirt Size:

(Please specify Youth or Adult size)

Lives With:

Mother Father Other

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 *

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, *

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

Signature

Relationship to player, and today's Date *

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