Player Registration

 

Player's Information

*First Name:

 

 

*Last Name:

 

 

*Nickname or Name Player Is Called By:

 

 

*Birth Date: (mm/dd/yyyy)

 

 

*Gender:

  Select Gender Male Female

 

*Address:

 

 

*City:

 

 

*State:

  Select State PA OH WV

 

*Zip: (xxxxx)

 

 

*Home Phone: (xxx-xxx-xxxx)

 

 

*League:

  Select League Miracle Division Competitive Youth Division Adult Division

 

*Buddy Needed?: (Non-Comp League req'd. Comp & Adult League optional.)

  Yes/No Yes No

 

*Shirt Size:

  Select Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL

 

*Seasons Played:

 

 

Interests or any "Fun Information" to help Player and Buddy bond:    

 

Player's Medical Information

*Disability/Diagnosis:      

    

Uses:  Wheelchair     Walker     Crutches

    

*Special Needs and Specific Help the Player Will Need: 

    

*Medications:

 

*Allergies:

 

Primary Care/Physician and Phone Number:

 

Requests:  (team, buddy, sibling, manager, etc.)

 

Parent/Guardian's Information

Parent/Guardian #1

 

*First Name:

 

 

*Last Name:

 

                   

*Cell:  (xxx-xxx-xxxx)

                 

 

*Email:

 

    

Volunteer Positions If Desired (not mandatory)

         First Choice:

         None Announcer Buddy Team Leader Buddy Coach Manager Team Parent Umpire Game Coordinator

        Second Choice:

         None Announcer Buddy Team Leader Buddy Coach Manager Team Parent Umpire Game Coordinator

        Shirt Size:

         Select Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL

               

Parent/Guardian #2

 

First Name:

 

Last Name:

                   

Cell:  (xxx-xxx-xxxx)

                

 

Email:

    

Volunteer Positions If Desired (not mandatory)

         First Choice:

         None Announcer Buddy Team Leader Buddy Coach Manager Team Parent Umpire Game Coordinator

        Second Choice:

         None Announcer Buddy Team Leader Buddy Coach Manager Team Parent Umpire Game Coordinator

        Shirt Size:

         Select Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL

 

Emergency Contact

*Contact Name:

 

 

*Contact Phone:  (xxx-xxx-xxxx)

 

 

Waivers

 

I give authorization for my child to participate in The Miracle League of Southwestern Pennsylvania, And do hereby released of any liability for injury that may occur while participating as a player or spectator during the season.
 

I hereby grant the Miracle League of Southwestern Pennsylvania, its affiliates, franchises, advertising and promotional agencies, and their agents, the irrevocable, unrestricted right to use, publish, display and distribute materials bearing my name, voice, likeness or any other identifiable representation of myself, my family members including my Miracle League player/child. These materials may appear in any form, style color or medium whatsoever (including, without limitation, photographs, video tapes, films sound recordings, software, drawings, prints, broadcast, internet and electronic media.) I agree that all material containing any identifiable representation of my child or family members (including without limitation, all negatives, plates and masters of any photographs, files, prints or tapes) shall be and remain the sole and exclusive property of the Miracle League. I hereby release and forever discharge the Miracle League from any and all liability and damages relating to the use of my child or family’s name, voice, likeness or any other identifiable representation. I hereby waive any right I may have to inspect or approve the finished materials or any part or element there of that incorporates my name, voice, likeness or any other identifiable representation of myself, my family including my Miracle League player/child. I have agreed to the above in consideration of the opportunity given to me by The Miracle League of Southwestern Pennsylvania to appear in these materials. I acknowledge that I have fully read and understand this document and that I have had any questions regarding its effect or the meaning of its terms answered to my satisfaction. I certify that I am at least 18 years of age and parent or legal guardian of the player shown above.

 

*Initials:  (must initialize to agree to waivers to register)

 

 

Please review all of your information that was

entered above before clicking on the OK Button.

 

Don't click the OK button more than once

 because you will double (or more) register.

 

Payment instructions will display

after clicking on the OK Button.