South Lawrence West Baseball & Softball (SLW)REGISTRATION FORM

Visit for registration dates and locations. /

Baseball Softball

/

Year: 2018

Baseball Fees :Instr (5-6) $60 Coach pitch (7-8)$75
Minors (9-10) $100 Majors (10-12) $125
90”ft diamonds (13-15) $135 /
Softball Fees: U10 (7-10) $75 U12 (10-12) $100
U14 (13-14) $125 U16 (15-16) $125
Today’s date: / Registration fee: / Receipt Number: / Primary Phone # / Email Address:

PARTICIPANT INFORMATION

Participant’s last name: / First: / D.O.B / Sex:
Male Female
Street address: / No. of years Playing / Shirt Size
City: / State: / ZIP Code:
MA

PARENT/GUARDIAN INFORMATION

Mother’s Name / Father’s Name
Mother’s address (if different from participant) / Father’s address (if different from participant)
Cell number / Cell number

EMERGENCY AUTHORIZATION

In case of emergency, I/We hereby authorize emergency treatment and/or care of the above participant at any hospital.
If in an emergency I/We cannot be reached, please contact: / Relationship to participant: / Phone number:

MEDICAL INFORMATION

Does the participant have a history of illness or allergies? Yes No
If yes, describe: / List any regularly taken medication: / Date of last Tetanus shot:

PARENT OR GUARDIAN AUTHORIZATION, DISCLAIMER, AND WAIVER OF LIABILITY

The above information is true to the best of my knowledge. To induce the South Lawrence West Baseball & Softball (SLW) to accept registration and permit participation in SLW by the above named participant, I the parent or guardian of said individual, hereby give my consent to agree to release, indemnify and hold harmless SLW, it's officials, managers, coaches, and representatives, from any claim arising out of injury or aggravated by my/our refusal to obtain available medical treatment based on religious or philosophical beliefs to the above named participants. I hereby grant permission to SLW to use my picture/likeness in its publications. This will only be used for non-commercial purposes.
I consent to and attest to all the information on this form.
Parent Signature / Date

2017-SLW-Baseball-and-Softball-Registration-1 (1) LAST REVISED 10/3/2018