Player First Name *
Player Last Name *
Age *
Player School (if applicable)
Player Shirt Size *
Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large Youth Small Youth Medium Youth Large Youth X-Large
Social Service Agency (if any)
Parent/Guardian First Name *
Parent/Guardian Last Name *
E-mail Address
Address *
City *
State *
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code *
Phone *
Authorization and Consent
I give authorization for my child, or agree to participate in the Miracle League of Blair County. Participation in baseball may result in serious injuries and protective equipment does not prevent all injuries. I do hereby waive, release, absolve, indemnify, and agree to hold harmless the Miracle League of Blair County and their organizers, sponsors, agents, insurers, supervisors, participants, and volunteers from any claim rising out of any injury to my/our child or myself whether the result of negligence or for any other cause.
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