Wallkill Valley Recreation Softball Registration

Wallkill Valley Recreation Softball Registration Form
(Grades 3-8 Personal Helmets strongly suggested)
Player Information
First Name:
Last Name:
Today’s Date:
Address:
Date of Birth:
City:
State:
Age:
New Jersey
Zip:
Grade (during the season):
School:
Rookies (Grades K-2) Uniform Shirt Size:
YS (6-8)
YM (10-12)
(Uniform Consists of Shirt, Socks, Hat)
YL (14-16)
Grades 3-8 Uniform Sizes (Consists of Shirt, Shorts, Socks, Hat)
Adult Small
Adult Medium
Adult Large
Photo Release: I herby authorize the use of my
child’s photo for publicity purposes
Signature:_______________________________
Adult X-Large
Prefer Same Coach:
Yes
Previous Coach:
Did the player participate last season?
Yes
No
No
Volunteer Information *Volunteer coaches and assistants are always needed*
Name
Coach
Assistant
Phone Number
Comments
Other
Primary Guardian Contact Information (Who will the coach/league contact)
Name:
Home:
Cell:
Email:
Emergency Contact Information (If the primary guardian is unreachable)
Name:
Home:
Cell:
Insurance Information & Medical Release (Write on back if more space needed)
Medical Insurance Provider:
Policy Number:
Physician:
Phone Number:
Known Allergies:
The above applicant is in good physical and mental condition and requests enrollment in the Wallkill Valley Rec Softball Program.
I/We, the parents or guardians of the above named child hereby give my/our approval to his/her participation in the Wallkill Valley Rec Softball program.
I/We assume all risks and hazards incident to such participation. I/We realize there is a risk of injury to children playing/participating in softball
activities/sports, and I/we do hereby release, absolve, indemnify and agree to hold harmless the Wallkill Valley Rec Softball League, directors, coaches,
officers, trustees, instructors, sponsors, commissioners, participants and persons supervising and/or coaching my/our child.
Print Name:
Signature:
Date:
Payment Information
$45 (Grades K-2)
$60 (Grades 3-8 NO UNIFORM INCLUDED)
$75 (Grades 3-8 UNIFORM INCLUDED)
Registration paperwork and payments due no later than March 1st
Grades 3-8 if played last year what was your uniform number:
(Players uniform numbers stay with them until they leave the league)
Cash
Check
Check Number
Name On Check
PLEASE PROVIDE A COPY OF YOUR CHILDS
BIRTH CERTIFICATE AT REGISTRATION
Make Check or Money Order Payable to: WVGS REC
Mail Registrations to:
Wallkill Valley Recreation Softball
PO Box 129
Franklin NJ 07416