Pilney Little League Baseball & Softball Registration Form - 2000

Player Information	Parent or Guardian Information
Player Birth Name___________________________________ Nickname______________________________________________ Address_______________________________________________ City__________________________________________________ Zip Code_______________ Home Phone______________________ School________________________________ Grade___________ Player Birth Date ________________Male Female (circle one) Family Health Plan_____________________ Policy No._________ If HMO or PPO, which hospital?____________________________	Father’s Name__________________________________________ Address_______________________________________________ City__________________________________________________ Zip Code_______________ Home Phone_____________________ Work Phone __________________Beeper___________________ Occupation____________________________________________ E-MAIL ADDRESS__________________ ___________________		Mother’s Name_________________________________________ Address_______________________________________________ City__________________________________________________ Zip Code ________________Home Phone____________________ Work Phone __________________Beeper ___________________ Occupation____________________________________________ E-MAIL ADDRESS______________________________________
PARTICIPATION AGREEMENT
Participation in Little League baseball requires the ability to run, throw, swing a bat, and catch a ball. Additionally, participation requires the capacity to understand the rules of the game. Does your child have a current condition that limits his/her ability to participate in this activity? Please circle one: NO YES. If yes, please explain and identify any modification that would allow your child to participate and provide information about allergies or any medical conditions that the team should have in case of an emergency: èè Will this player will be participating in another baseball league concurrent with the Pilney season’s date? YES NO I/we know that participation in baseball may result in serious injuries. Protective equipment does not prevent all injuries to players. I hereby waive, release, absolve, indemnify, and agree to hold harmless the Local League (Pilney Little League), Little League Baseball, Inc., the organizers, sponsors, participants, and persons transporting my/our child to and from activities from any claim arising out of any injury to my/our child whether the result of negligence or for any other cause, except to the extent and in the amount covered and actually paid by accident or liability insurance. I/we waive any right to recovery or subrogation for any amounts paid by any insurer for damages or medical expenses. I/we agree to return all equipment issued by Pilney Little League in as good a condition as when received except for normal wear and tear. I understand that no refunds of membership dues will be made except by majority vote of the Pilney Board of Directors. Signature of Parent or Guardian (X)__________________________________________________________Today’s Date_________________________________
UNIFORM PURCHASING INFORMATION		FOR LEAGUE USE ONLY:
Circle a uniform size for the player registered on this form: Youth Small YS Adult Small AS Youth Medium YM Adult Medium AM Youth Large YL Adult Large AL Add $3.00 per shirt if ordering sizes Adult XXL or XXXL Adult Extra Large XL If you wish to purchase extra uniform shirts, add $8.50 for each to the membership dues.		Player’s Birth Date______________________ League Age on July 31, 2000_________________ Document Type: Birth Certificate  Passport  Birth Certificate Copy  No_____________________ Names of others included with this payment:_____________________________________________ Membership Dues Paid: $________ Cash  Check  M.O.  Check No.____________ League Official Signature_____________________________________Date___________________

HOW DID YOU FIND OUT ABOUT PILNEY LITTLE LEAGUE? Played Before / Street Sign / Newspaper Ad/ Word of Mouth / Friends Played Here/ Other ____________ (circle one)