1020 Broadway, Apt 7 Woodmere, N.Y.

11598
(516) 382-7525
_______________ Season Baseball Registration Form
REGISTRATION FEE: $__________
UNIFORM FEE: $___________
PRINT
Childs Name __________________________________________ Tel.#________________________ Sex ______
Address _____________________________________________________________________________________
School ______________________________________________ Grade _____ Birth Date ____________________
PARENTS INFORMATION:
Mother ______________________________________________________ Cell ___________________________
Father _______________________________________________________ Cell ___________________________
EMERGENCY CONTACT _________________________________ Tel. # ______________________________
Parents Email address __________________________________________________________________________
REMARKS __________________________________________________________________________________
I/We, the parent(s) of the above named candidate for a position on the Long Island Royals 11U team, hereby give my/our approval to
participate in any and all Long Island Royals 11U activities, including transportation to and from the activities. I/We know that
participation in baseball may result in serious injuries, and protective equipment does not prevent all injuries to players. We do hereby
waive, release, absolve, indemnify and agree to hold harmless the Long Island Royals, the organizers, sponsors, supervisors, participants
and persons transporting my child to and from activities for any claim arising out of any 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 will furnish a birth
certificate for the above named child to League officials if required.

Parent/Guardian Signature __________________________________________ Date _______________________

TEAM USE ONLY

Registration Fees _______________
Amount Paid _______________
Balance Due _______________
Birth Certificate Verified _________ Payment Received by __________ Cash _________ Check # ___________
Entered on ____________ By ____________

Registration Date _______________________

*PLEASE ATTACH A COPY OF THE PLAYERS BIRTH CERTIFICATE