| Player | Male Female | T-Shirt Size | Small Medium Large X-Large | ||||||||||||||||||||||||||
| First Name | Last Name | Phone | |||||||||||||||||||||||||||
| Address | Birthdate |
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School | ||||||||||||||||||||||||||
| Parent/Guardian #1 | |||||||||||||||||||||||||||||
| First Name | Last Name | Phone | |||||||||||||||||||||||||||
| Address | Email Address | Cell Ph. | |||||||||||||||||||||||||||
| Would you like to Volunteer?? | Yes No | ||||||||||||||||||||||||||||
| Parent/Guardian #2 | Blank fields for Parent/Guardian #2 will be copied from Parent/Guardian 1 above | ||||||||||||||||||||||||||||
| First Name | Last Name | Phone | |||||||||||||||||||||||||||
| Address | Email Address | Cell Ph. | |||||||||||||||||||||||||||
| Would you like to Volunteer?? | Yes No | Emergency Contact | |||||||||||||||||||||||||||
| Name | Relationship | Phone | |||||||||||||||||||||||||||
| Major League Eligibility | Yes No | ||||||||||||||||||||||||||||
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If your child is 10, 11 or 12 years old and is interested in being eligible for the Major League
Draft select "Yes" above. *** All players who want to be eligible for the Major League Draft must try out. *** |
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| Health Issues/Physical Limitations | Yes No | ||||||||||||||||||||||||||||
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If your child has any health issues or physical limitations that you want us to be aware of, please select "Yes" above. You may use the comments section to provide any relative information, however, if you would prefer to be contacted directly by a league officer to discuss, please note that in the comments section below. |
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| Comments (i.e. requests, concerns, physical limitations, ...) | Additional Email Adresses (optional) | ||||||||||||||||||||||||||||
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Payment Information | ||||||||||||||||||||||||||||
Churchill American LL c/o Pat DeVivo 129 Pearl Street Melrose, MA 02176 Please note your registration number(s) on the check. This number will be emailed to you once you submit this registration. First year players should also send a photo-copy of their birth certificate. Also, for families with multiple children in the league, there is a $120.00 maximum per family. If you are registering multiple players and paying by check, please send a single check with the registration numbers noted on the check. Your registration number will be emailed to you once your registration is submitted. |
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| Disclaimer | |||||||||||||||||||||||||||||
| I, the parent/guardian of the above named candidate for a position on a Little League team, hereby give my approval to participate in any and all Little League activities. I assume all risk and hazards incidental to such participation including transportation to and from the activities. And, I do hereby waive, release, absolve, indemnify and agree to hold harmless the local Little League, Little League Baseball Incorporated, organizers, sponsors, supervisors, participants, volunteers and persons transporting my child to and from activities, for any claim arising out of an injury to my child, whether the result of negligence or for any other cause, except to the extent and in the amount covered by accident or liability insurance. I agree to return upon request the uniform and other equipment issued to my child in as good a condition as when received except for normal wear and tear. I will furnish a certified birth certificate of the above named child to the League Officials. | |||||||||||||||||||||||||||||
Step 1. (Security Challenge)
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Instructions Step 1. Complete the security challenge on the left by entering the two words displayed in the white box. Step 2. Click on the "Save Registration" button to save the completed form; this will save the registration and bring you to the payment page (if you have not yet paid). Step 3. After completing steps 1 & 2 for the current registration, you can register additional siblings by clicking on the "Register Sibling" button and repeating the process as necessary for each additional player. Step 4. When you are done registering, click the "Done" button. Note: If you are having trouble reading the CAPTCHA words, you can click on the circular arrows for a new set of words. Also, the security challenge is ONLY required for the "Save Registration" button. Note: If you will be paying by check, please follow the instructions above in the "Payment Information" section. | ||||||||||||||||||||||||||||
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