Registration & Consent Form
Please print or type
Birmingham Little League Baseball 2017
Player’s Name
Last / First / M. / Birth Date*A certified birth certificate may be required
Address
Street
/ City / Zip**Please check Birmingham Little League boundaries on the back of this registration package.
Profile
/Age on 8/31/17
Height / Weight / Sex /School
/Grade
ft. / in.Contact Numbers
Area Code
/ Telephone Number / E mail AddressParents / Guardians
Mother (please print)
/ Father (please print)***Parents Requests for friends being on the same team cannot be honored, since all player selection will be done through a draft. Once assigned to a team, a player cannot be transferred; neither can a refund be made
Other Information
What other spring sports will your child be playing? /Travel or
House
/ What team did your child play on last year in BLL / Number of years playing organized Little LeagueWe Need your HELP!!! If you are willing to assist, please indicate any of the following:
Manager
/Coach
/ Umpire ( paid position) /Sponsor
If so, please contact Dave Palmeri at:Players Fee - $150.00 – per playerAll Divisions
$110.00Tee Ball ONLY
I wish to contribute the following amount in
support of Birmingham Little League Baseball. + / MAIL TO: Birmingham Little League
P.O. Box 2536
Birmingham, MI48012-2536
After 2/15/15 – Fees are adjusted to $175
MAXIMUM FAMILY COST $300.00
TOTAL
IMPORTANT – PLEASE CONTINUE ON BACK
WAIVER
I/We, the parents/guardians of the named player for a position on Birmingham Little League, Inc. baseball 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 participation in baseball or 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 Birmingham Little League, Inc., their Board of Directors, Little League Baseball, Incorporated, managers, umpires, the organizers, sponsors, supervisors, participants, Birmingham Public Schools, Birmingham Parks & Recreation Department and persons transporting my/our child to and from activities for any claims arising out of any injury to my/our child whether the result of negligence or for any other cause.
I/We agree to return upon request the uniform and other equipment issued to my/our child in good condition as when received except for normal wear and tear.
I/We agree to provide proof of legal residence (as defined by Little League Baseball, Incorporated) and age. I/We understand that our child must be eligible under residence and age regulations of Little League Baseball, Incorporated, to participate in this Local League, and if any controversy arises regarding residence and/or age, the decision of the Board of Directors Charter Committee in Williamsport shall be final and binding. I/We further understand that if any participant on a Little League team does not qualify for participation in the league based on residence (as defined by Little League Baseball, Incorporated) and/or age, such participant and/or team on which he/she participates be found ineligible, and forfeit(s) and/or suspension of Tournament privileges may be decreed by action of the Charter Committee or Tournament Committee.
I/We understand that my/our child may be chosen to play on a Junior/ Major/Association/Minor/Coach Pitch division team, if he/she is of the correct age/ability for such division as determined by the Birmingham Little League, Inc. and Little League Baseball, Incorporated. Declining to play in such division or assigned team could possible result in forfeiture of eligibility for the current season, and may be subject to further restrictions by the Birmingham Little League, Inc.
MEDICAL RELEASE / CONSENT FOR TREATMENT
In my/our absence, I/We authorize medical, surgical and dental treatment, both emergency and non-emergency, considered necessary and proper for the diagnosis and treatment of my/our child listed previously.
I/We further authorize the manager or coach, assistant managers or coaches to cause my/our child be transported to the nearest medical facility for treatment of any illness/injury as above.
Medical Information
Family Physician / Telephone / Hospital PreferencePlease list any allergies, medical problems or physical limitations
Medical Condition / MedicationI/WE HAVE READ THE ABOVE WAIVER AND CONSENT, AND UNDERSTAND THEM, AND BY SIGNING BELOW, I/WE AGREE TO THEM.
______
Parent/ Guardian SignatureParent/Guardian Signature
______
Home PhoneCell PhoneHome PhoneCell Phone
Little League Baseball does not limit participation in its activities on the basis of disability, race, color, creed, national origin, gender, sexual preference or religious preference.