Holbrook Regional Recreation Department

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Boys Pee Wee Basketball Registration Form

PLAYER INFORMATION

* Last Name:

* First Name:

* Street:

* City:

* State:

* Zip Code:

* Birthdate:

* Home Phone:

* Email:

* Gender:

* Grade:

Comments::

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Home Phone:

* Work Phone:

* Cell Phone:

Volunteer:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

Volunteer:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

I/We, the parents of the above named candidate for a position on a Farm League, Softball or T-ball team, hereby give my/our approval to participate in any and all League activities, including transportation to and from activities.
I/We know that participation in baseball, t-ball 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 local League, organizers, sponsors, supervisors, participants, and persons transporting my/our child to and from activities from any claim 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 as good conditions as when received except for normal wear and tear.
I/We agree that our child may be required to try out for a team. If such does not attend at least 50 percent of the tryouts, local directors' approval is required for such a candidate to be placed on a team.
I/We will furnish upon request a certified birth certificate of the above named to league officials.

I/we agree with the above *

* Shirt Size:

Team Last Season:

* School:

* indicates required fields

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Boys Pee Wee Basketball Registration Form