Central Coast Double AA League BASEBALL Registration Form

Central Coast Double AA League Registration Form
Date Today

MonthDayYear
Date
Player Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Age
ADDRESS MAIL IS RECEIVED

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of School, Day Program or Residential Home, if applicable

Email
example@example.com
Team Application Information
Youth
Note: DP Little League Challenger Program Option for Youth 4-14 yrs, dpll.net
10-12 category
Note: DP Little League Challenger Program Option for Youth 4 -14yrs. dpll.net
13-15 category
Note: DP Little League Challenger Program Option for Youth 4-14 yrs. Old, dpll.net
Youth or Adult
Desired Division
Desired Position

Emergency Contact Information
Name of Emergency Contact

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relation to Athlete

Parental/Guardian Consent
Name of Doctor

First NameLast Name
Confirm (Parents or Legal Guardian, Conservator - Box #1) OR Legal Adult Participant, Box #2

I hereby declare that in my full knowledge and capacity, I give my express and full permission to let my child or conserved child/adult be treated by qualified medical physician in any circumstance that such attendance be so required to perform all or any immediate medical check-up or treatmentLegal Adult Participant, Confirm: I hereby declare that in my full knowledge and capacity, I give my express and full permission to be treated by a qualified medical physician in any circumstance that such attendance be so required to perform all or any immediate medical check-up or treatment
Clinic / Hospital
Waiver I am fully aware that this sport activity may cause accidental injury to athletes. I likewise assume any and all possible risk that may cause injury, illness, or death arising to such activity. I hereby declare that I waive my right to pursue any and all claims against the City and County of Santa Barbara, Central Coast Adaptive Athletics and Santa Barbara Special Needs Adaptive Programs, Affiliate Organizations and their Leaders, Coaches, Volunteers and Organizing Committee at or for this event should in any case the accident, injury, illness or death occurs in the course of any activity held by them.
Signature of Parent / Guardian / Conservator

Clear
Name

First NameLast Name
Date Signed

MonthDayYear
Date
Email
example@example.com
Should be Empty:

Central Coast Double AA League Registration Form

Team Application Information

Emergency Contact Information

Parental/Guardian Consent