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      Wilton Manors Baseball (Since 1955) Last Updated: July 10, 2009 www.leaguelineup.com/wiltonmanors  

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    Wilton Manors Little League Registration

    ! Indicates required information

    PLAYER INFORMATION
     ! First Name: 
     ! Last Name: 
    Street: 
    City: 
    State: 
    Zip Code: 
    Home Phone: 
    Birthdate: 
    Email: 
    Gender: 
    Grade: 

    PARENT/GUARDIAN #1
     ! Firstname: 
     ! Lastname: 
    EMail: 
     ! Home Phone: 
    Work Phone: 
    Cell Phone: 

    PARENT/GUARDIAN #2
    Firstname: 
    Lastname: 
    Email: 
    Home Phone: 
    Work Phone: 
    Cell Phone: 

    MEDICAL/EMERGENCY CONTACT INFORMATION
    Emergency Contact: 
    Phone: 
    Relationship to Player: 
    Insurance Carrier: 
    Policy #: 

    WAIVER INFORMATION
    I/We, the parent(s) or legal guardian(s) of the above named child and candidate for a position on a Little League team, hereby give my/our permission and approval to participate in any and all Little League activities. I/We know that participation in baseball may result in serious injuries and that protective equipment does not prevent all injuries to players and do hereby waive, release, absolve, indemnify and agree to hold harmless Wilton Manors Baseball, Little League Incorporated, the organizers, sponsors, supervisors, board members and officers, participants and persons transporting my/our child, whether the result of negligence or for any other causes, except to the extent and in the amount covered by accident or liability insurance. I/We agree to return upon request the uniform and/or other equipment issued to my/our child in as good condition as when it was received, except for normal wear and tear. I/We will furnish a certified birth certificate of the above named candidate to Little League Officials upon request.
       I/we agree with the above  ! 

    ! Indicates required information


       



    Wilton Manors Baseball (Since 1955)
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