Long Island Mudcats

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Player Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

State:

Zip Code:

* Home Phone:

* Birthdate:

* Age on 5/1/2022:

Gender:

* Uniform number preference, list at least 3 in order of preference:

* Jersey Size(ex. Youth Medium, Adult Small):

* Uniform Pants Size (ex Youth Medium, Adult, Small, etc):

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:

WAIVER INFORMATION

Please read the following statement completely.

On behalf of my child, I, the parent/guardian of the applicant, apply for registration to try out for Long Island Mudcats Baseball. I hereby give my child my approval for his or her participation in all Long Island Mudcats activities. Upon request, I agree to furnish a certified birth certificate of the applicant.

I agree to provide comprehensive medical insurance for the applicant or otherwise accept responsibility for all medical expenses arising out of injury to my child during activities. I agree to assume all risks and hazards related to his or her participation, including transportation of my child to and from any activity.

I forever hold harmless and indemnify the Long Island Mudcats, managers, coaches, umpires and other agents from any and all claims and damages resulting from any and all actions arising out of my child's participation in Long Island Mudcats activities.

I understand that I, a family member and/or my child may be expelled from the Long Island Mudcats for any conduct deemed detrimental to the Long Island Mudcats, and my child may be expelled from the Long Island Mudcats for any detrimental conduct by a family member or me.

I/we agree with the above *

* Parent, Guardian or Adult E-mail:

* indicates required fields

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Player Registration Form