2024 Huffman Baseball Registration Form

PLAYER INFORMATION

EARLY REGISTRATION ENDS ON JANUARY 4, 2025
Player Name*

First NameLast Name
Player Birthdate*

MonthDayYear
Date
Baseball player age on May 1, 2025*
Gender*
Grade
Player Position
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is there a 2nd player?*

YesNo

Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone*
Parent/Guardian E-mail*
example@example.com
Occupation
Interested in Volunteering

YesNoMaybe
Parent/Guardian #2

First NameLast Name
Parent/Guardian Phone #2
Parent/Guardian E-mail #2
example@example.com
Parent # 2 Occupation
Parent #2 Interested in Volunteering

YesNoMaybe
Emergency Contact*
Relationship to Player
Emergency Phone Number*
Please enter a valid phone number.
Medical Information
Insurance Carrier*
Policy #
Primary Care Physician and Phone Number
Dental Provider and Phone Number
In the event reasonable attempts to contact the parents or guardians have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by preferred doctor (2) or preferred dentists or in the event designated doctor or dentist is not available, by another licensed physician or dentist; and (3) the transfer of the child to preferred hospital or any hospital accessible. NOTE: This authorization does not cover major surgery unless the medical options of the two other licensed physicians or dentists, concurring in necessity for such surgery are obtained BEFORE the surgery IS PERFORMED.
Please read statement above and check if declining

I do not give consent for emergency medical treatment of my child, In the event of illness or injury requiring emergency treatment, I wish for Huffman Recreation Board to take no action
Initial for Declination
Consent
Parents Responsibility Pledge*
Please read and sign: I, the parent/guardian of the Athlete named above, hereby give permission for my child to participate in team activities, as directed by the park/coach. I understand that there is an inherent risk of injury in sports, particularly with contact sports. *

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Date*

MonthDayYear
Today's Date
Calculation*
Total Price*
Coupon Code
PAYMENT

All fees and discounts are already applied
TOTAL BASEBALL FEE(S)*

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PLAYER INFORMATION

Parent/Guardian Information

Medical Information

Consent

PAYMENT