Sample Page

Player Registration Form

Step 1 of 2

PLAYER'S Full Name(Required)

First Last

Name on Back of JERSEY(Required)

Age(Required)

Date of Birth(Required)

Parent / Guardian's Full Name(Required)

Email(Required)

Address(Required)

Mailing Address City State / Province / Region ZIP / Postal Code

Cell Phone(Required)

Home Phone

Work Phone

Player's Disability / Types of Assistance Needed(Required)

Coach Requested (as available)

Which type of Buddy for your player(Required)

Uniform Shirt Size: (Choose One)(Required)

Please read and sign the following: As a parent / guardian I understand that I am to stay on the premises during my players' games and practices. I have read the Expectations of Play and will comply with that set forth by the MLP Board of Directors. I also agree to participate in all MLP fundraisers (selling) in order to help maintain our affordable registration fees.

Signature of Parent / Guardian(Required)

Date(Required)

In consideration for the Miracle League of Northeast Pensacola. Inc. providing the opportunity for my child to participate inthe Miracle League Baseball, the undersigned does hereby release and agree to indemnify and hold harmless the Miracle League of Northeast Pensacola. Inc. and its officers and directors from any and all claims for personal injury. death, property damage, or any type of claim or damage (including but not limited to attomey's fees or litigation expenses) resulting from my child's activities in connection with participation in Miracle League baseball or the participation of any family member or guest of the undersigned I assume all risks and hazards incidental to such participation in Miracle League games and activities and consent for my child to receive first-aid and / or emergency care by a qualified Emergency Medical Technician or physician or other person qualified to render medical assistance in the event my child suffers an injury during sanctioned games and activities. I agree to provide my child's specific medical information to the Miracle League of Northeast Pensacola. Inc. so that appropriate precautions and care can be provided to my child during sanctioned games and activities. I/We agree to be present at all games and activities so that I/We can manage our child's specific needs. I agree to have any and all medication (prescription and non- prescription) for my child and shall be solely responsible for dispensing any such medication to my child. We agree to abide by all of the COVID-19 policies put in place and release Miracle League of Pensacola from all liability for unintentional exposure or harm due to COVID-19.

Parent/Guardian Signature(Required)

Date(Required)

I/We understand that there will be media and promotional coverage of Miracle League Games and activities and I/We give our consent to publish my/our child's name and picture for such purposes. I hereby grant the Miracle League Association, its affiliates, franchises, advertising and promotional agencies, and their agents, the irrevocable, unrestricted right to use, publish, display and distribute materials bearing my name, voice. likeness or any other identifiable representation of myself. my family members. including my Miracle League player/child. These materials may appear in any form, style, color or medium whatsoever (including, without limitation. photographs, video tapes, films, sound recordings. software, drawings, prints. broadcast. internet and electronic mediaI agree that all material containing identifiable representation of me (including without limitation, all negatives, plates and mastersof any photographs. files. prints or tapes) shall be and remain the sole and exclusive property of the Miracle League Association I hereby release and forever discharge The Miracle League Association from any and all liability and damages relating to my name, voice. likeness or any identifiable representation of me. I hereby waive any right I may have to inspect or approve the finished materials or any part of element thereof that incorporates my name, voice, likeness or any other identifiable representation of myself, my family. including my Miracle League player/child. I have agreed to the above in consideration of the opportunity given to meby the Miracle League Association to appear in these materials.

Parent/Guardian Signature(Required)

Date(Required)

Payment Option(Required)

Pay By Credit Card

Request a scholarship

Pay by Check or Cash

Pay In Person

Player Name(Required)

Why do you need scholarship?(Required)

Please bring cash or check payment to registration days at the park or first game day

Player Registration

Credit Card(Required)

Cardholder Name

Card Details

Signature(Required)

Player Registration Form

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