Baseball Sign Up Form

Player's Name

First NameLast Name

Age

Birthday

Sex

School or Organization

Parent/Guardian Name(s)

Main Phone Number

Area CodePhone Number

Cell Phone Number #1

Cell Phone Number #2

Email address

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Names of siblings Participating in ABLE

Emergency Contact

First NameLast Name

Relationship

Contact's Phone #

Area CodePhone Number

Contact's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Does this player have a disability

If so, What is/are the diagnosis

Does this player have seizures

If so, how severe

Does this player use a wheelchair

Does this player use a walker or braces

Does this player have allergies and/or diet restrictions

If so, please describe

Please describe any communication or behavioral issues

What accommodations would this player require to be successful in this program(handicap accessible, sign language, hand over hand assistance, visual or hearing assistance, tee stand colored balls or plates, etc.):

As the parent/guardian of the above named player, I understand that the Adapted Baseball Program staff, and volunteers will only use the above information to effectively assist my child during league activities and that all information will be kept confidential.

I understand that the Adapted Baseball Program is NOT to be utilized as a "Child Care Program" and that myself or another caregiver that has been appointed by me will be with this player at all times

I understand that this player may be photographed while participating in the Adaptive Baseball Program. I further understand and agree that this player's picture may appear on the ABLE Recreation website, printed materials, or photo sharing website. ABLE Recreation may authorize the release of these photos to other related organizations and media for the purpose of promoting the program. I understand ABLE Recreation will NOT release this player's name or personal information.

I grant permission for the Adapted Baseball Program to obtain medical assistance for the above named player in the event of an injury/illness during program activities IF this player's guardian is unavailable.

ABLE Recreation Inc. including the director, staff and volunteers, as well as Watauga County Parks & Recreation, Watauga County Special Olympics and all of their staff/volunteers will be held harmless against any injuries and/or illnesses resulting from this player's participation in the program

I certify that the above information is accurate to the extent of my knowledge.

A team uniform will be provided to all participant's of this program. Please supply us with the player's tee shirt size (hats will be adjustable).

The registration fee to participate in this program is $20.00 per player. You have the option of mailing the registration fee to ABLE Recreation, Inc. 153 Summer Place Drive Boone, NC 28607 OR it will be collected during final registration at the first game. All fees need to be paid before uniforms are handed out. Please direct all questions to Melissa Shore at (828) 964-9299 or ablerec@yahoo.com.

Parent/Guardian Information

Emergency Contact Information

Participant Information