EVERETT LITTLE LEAGUE

REGISTRATION - 2008 SEASON

Player's name _______________________________ Date of Birth _____________

Address _____________________________________________________________

Home phone ________________________ Day/Cell phone ___________________

Emergency contact:___________________ Emergency phone ________________

What team/Div. last year? ______________________________________________

Medical conditions ( asthma, allergies. etc.)________________________________

________________________________________________________________

Prescription medications? ______________________________________________

I would like to volunteer for the following essential league activies:

please cicle choices

Manager / Coach        Fund Raisers        Concession Stand        Cookout

I, the parent/guardian of the above named child, hereby give my approval to participate in any and all

activities of  the Everett Little League program, and do hereby waive, release, absolve, indemnify and

agree to hold harmless Everett Little League, Little League Baseball Inc., the organizers, sponsors,

supervisors, participants, and persons tranporting my child to and from activities for any claim arising

out of  any injury to my child whether the result of negligence or from any other cause.

Signature _________________________________ Date _______________________

Special request(s)_________________________________________________

************************ for league use only ***************************

PAID check # _________           NOT PAID ________  League Age ________

Cash    _________            Amt. due    ________      League __________

Raffles given?  Y  /  N      Birth Certificate ?  Y  /  N

Registration fee $ 60.00

Please make checks payable to Everett Little League