Harlem Little League: 2010 Waitlist Application

2010 Player WaitList

PLAYER INFORMATION
Player's First Name:
Player's Last Name:
Birthdate: mm/dd/yy
Gender:
Address:
Apartment Number:
City:
Zip code:
Is this a New Address?
Day Phone: (No spaces)
Evening Phone: (No spaces)
Cell Phone: (No spaces)
Preferred Email:
Please retype email:
Did your child play HLL in 2009?
I want my child to play:
School Attending:

Is a brother or sister applying to HLL?
Brother or Sister's Full Name:
MEDICAL INFORMATION
Emergency Contact's Full Name:
Emergency Contact's Phone: (No spaces)
Emergency Contact's Relationship to Player:
Medical Condition (If none, Please type None):
PARENT/GUARDIAN INFORMATION
1. Registering Parent's First Name:
Registering Parent's Last Name:
Does Player Live with Registering Parent?
Registering Parent's Occupation:
2. Parent's First Name:
Parent's Last Name:
Does Player Live with Parent #2?
Parent #2 Occupation:

PARENT/GUARDIAN PERMISSIONS AND UNDERSTANDINGS:

I/We the parents(s) or guardian(s) of the above individual player, hereby, give my/our approval for participation in any and all Harlem Little League activities, including transportation to and from scheduled activities.
I/We know that participation in baseball/softball may result in serious injuries, and that protective equipment may not prevent all injuries to players.
I/We do hereby waive, release, absolve, indemnify and agree to hold harmless Harlem Little League, Little League Baseball, Inc., organizers, sponsors, supervisors, volunteers and persons transporting by/our child to and from activities for any claim that may arise out of injury to my/our child in the amount covered by accident or liability insurance.
I/We agree to provide proof of legal residency and age as defined by Little League Baseball, Inc. and that I/we understand that my/our child must be eligible under the residence and age regulations of Little League Baseball, Inc. for participation in tournament play.
I/We also understand there will be no refunds once uniform is received by the player.
I/We authorize that in case of emergency, if family member is not present and cannot be reached, my child can be treated by Certified Emergency Personnel (EMT, First Responder, Emergency Room Physician, etc.)
I/We understand that Harlem Little League is an all volunteer organization where no one gets paid. Therefore, I/ We are expected to help out whenever and wherever possible to make the operations of the League run smoothly for the children of the League.
I/We will contact Harlem Little League immediately if my child (ren) no longer wishes to play or cannot attend games consistently.
I/We give permission to Harlem Little League and Little League Baseball and Softball International, Inc. to use photographs and video of the above named minor in any publication, media release, or promotional announcement, electronic or otherwise. I/We agree that the above named minor, nor I/we, nor any family member, nor any organization is due any compensation if such images appear in any publication, media release advertisement or promotional announcement, electronic or otherwise.

PARENT & GUARDIAN'S AGREEMENT:

Please put initials in the box to indicate that I/we have read and agreed to the permissions and understandings; that I/we are 18 years and older and that I/we are the parent/legal guardian of the registered player.