Registration Form - Ridgebury Little League
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1RIDGEBURY LITTLE LEAGUE REGISTRATION FORM
NORTHERN TIER LITTLE LEAGUE * LEAGUE ID # 238-15-15
PLEASE PRINT:
Baseball
Softball
Player's Name ______________________________________________ Shirt Size _______________
Address ___________________________________________________________________________
City
State
Zip
Phone _______________________
Date of Birth _____/_____/_____
Male
Female School ______________________________
Father’s Name ____________________________
Mother’s Name ___________________________
(or legal Guardian)
(or legal Guardian)
Address
_________________
Address
_________________
(if different from above)
(if different from above)
_______________________________
_______________________________
Home Phone _____________________________
Home Phone _____________________________
Cell Phone _______________________________
Cell Phone _______________________________
E-mail Address ___________________________
E-mail Address ___________________________
Medical Information
Insurance Carrier _____________________________________________________________________
Medical or physical limitations (allergies, hearing, sight, etc.) __________________________________
____________________________________________________________________________________
I/We, the parents of the above named candidate for a position on a Little League team, hereby give my/our approval
to participate in any and all Little League activities, including transportation to and from the activities. I/We know
that the participation in baseball and softball may result in serious injuries and protective equipment does not
prevent all injuries to players, and do hereby waive, release, absolve, indemnify and agree to hold harmless the local
Little League, Little League Baseball Incorporated, the organizers, sponsors, supervisors, participants and persons
transporting my/our child to and from activities for any claim arising out of any injury to my/our child whether the
result of negligence or for any other cause, except to the extent and in the amount covered by accident or liability
insurance. I/We agree to return upon request the uniform and other equipment issued to my/our child in as good a
condition as when received except for normal wear and tear.
Parent(s)/Guardian Signature
Date
LEAGUE USE ONLY
Birth Certificate [ ]
Medical Release Form [ ]
League Age ______
Registration Fee [ ] Cash [ ] Check No. ___________
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