Kids Baseball Registration Form

Player's Name:*

First NameMiddle NameLast Name

Player's Date Of Birth:*

MonthDayYear

Player's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Phone:*

Area CodePhone Number

Home Email*

Mother's Name

First NameLast Name

Mother's Cell

Area CodePhone Number

Mother's Email

Mother's Cell Provider

Father's Name

First NameLast Name

Father's Phone

Area CodePhone Number

Father's Email

Father's Cell Provider

Authorization For Emergency Treatment

By submitting this form you give your consent for your child's participation in any and all STIX Baseball functions or activities. In the event of any injury or sickness occurring during any STIX Baseball 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 STIX Baseball and any person(s) connected with STIX Baseball 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 STIX Baseball 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 STIX Baseball coaching staff should be aware of are listed below.

Are there any medical conditions the staff needs to be aware of?

Comments:

In Case Of Emergency

Point Of Contact:*

Contact Number:*

Signed: Parent

Date:

MonthDayYear