Ligonier Valley Junior Legion

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PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

Zip Code:

Player's Phone Number (if applicable):

* Birthdate:

Grade:

* Primary Position:

Secondary Position(s):

Prior Pitching Experience *

PARENT/GUARDIAN #1

* First Name:

* Last Name:

* Phone #:

* Parent, Guardian or Adult E-mail:

PARENT/GUARDIAN #2

First Name:

Last Name:

Phone #:

Please list any medical conditions or concerns that the coaching staff needs to be aware of:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

I/we agree with the above *

* indicates required fields

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