Northeast Youth Baseball

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Player Registration

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, the parent or guardian of the above named player hereby give my approval for the above named youth to participate in the activities of Northeast Youth Baseball. I agree to furnish my child with an athletic supporter that will be worn to all practices and games for protection. I hereby acknowledge the fee paid is non-refundable. In addition, I understand that by agreeing to play in Northeast Youth Baseball, my child accepts the obligation to attend all practices and games. Participation in Northeast Youth Baseball does not preclude playing in any other league, but failure to attend Northeast Youth Baseball practices and games could be cause for dismissal. I, the parent/guardian, of the above named player, do hereby, for ourselves, our heirs and personal representatives, waive and release any and all rights and claims for damages which we may have against Northeast Youth Baseball, its agents, servants or employees, its sponsors and their successors or assigns or any other person, firm or corporation for any and all injuries which may be suffered by the above listed player and connection with participation and practices, league or tournament play or for accidents incidental to the conduct of activities and transportation to and from league activities. I hereby state that my child is in good health and able to participate in this program. I further acknowledge that I have read and fully understand the above mentioned facts. Also, in case of an emergency, I hereby give my permission for a program representative to call 911 and have my child transported to a hospital. I hereby agree to abide by the rules and regulations as established by Northeast Youth Baseball. I further agree when I leave this activity or at its completion, I will return any and all equipment issued to me.

I/we agree with the above *

* indicates required fields

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