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2022 Registration
PLAYER INFORMATION
*
First Name:
*
Last Name:
*
Age Group:
8u Bombers Baseball
9u Bombers Baseball
11u Bombers Baseball
12u Bombers Baseball
13u Bombers Baseball
15u Bombers Baseball
10u Lady Bombers Softball
12u Lady Bombers Softball
14u Lady Bombers Softball
18u Lady Bombers Softball
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Street:
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City:
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State:
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Zip Code:
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Home Phone:
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Birthdate:
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2021
Email:
PARENT/GUARDIAN #1
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Firstname:
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Lastname:
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EMail:
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Home Phone:
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Cell Phone:
PARENT/GUARDIAN #2
Firstname:
Lastname:
Email:
Home Phone:
Work Phone:
Cell Phone:
MEDICAL/EMERGENCY CONTACT INFORMATION
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Emergency Contact:
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Phone:
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Relationship to Player:
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Insurance Carrier:
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Policy #:
Registration Fee is $75
Checks Payable: Brushtown Bombers
Mail Checks: 15 Franklin Drive McSherrystown PA 17344
WAIVER INFORMATION
By submitting this form you give your consent for your child's participation in any and all Brushtown Bombers Baseball/Brushtown Lady Bombers Softball functions or activities. In the event of any injury or sickness occurring during any Brushtown Bomber Baseball/Lady Bombers Softball functions or activities, you authorize any official(s) to administer first aid and if necessary to transport your child to the nearest emergency treatment.
You release Brushtown Bombers Organization and any person(s) connected with Brusthown Bomber Baseball/Lady Bombers Softball of any responsibility from accident or injury incurred as a result of his participation in any and all activities, including transportation to and from any Brushtown Bombers Baseball/Lady Bombers Softball functions or activities.
You certify that you child has been given a physical examination and is physically able to participate in all related activities. Please notify in writing any prescribed medications and / or physical conditions of which the Brushtown Bombers Baseball coaching staff should be aware of are listed below.
I/we agree with the above
*
* indicates required fields