Howie’s Field of Dreams Signup

Roger N. Allen Baseball (Cal Ripken Baseball)

Application to participate in Roger N. Allen Baseball (ages 5-20)

Player Name * This field is required.

First Name

Last Name

Are you a returning player* This field is required.

YESNO

Player Diagnoses* This field is required.

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Birthday * This field is required.

Date

Phone Number* This field is required.

Area Code

Phone Number

Player's Current School* This field is required.

Name of Players Sibling(s) in League

Sibling 1

Sibling 2

Parent 1 Information* This field is required.

First and last name:

Please enter your phone

Please enter your email

Parent 2 Information

First and last name:

Please enter your phone

Please enter your email

Has the player had any injuries in the past?* This field is required.

YESNO

Player Jersey Size* This field is required.

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult X-Large

Jersey Number (Pick 3)

Please enter your first choice

Please enter your second choice

Please enter your third choice

Does the player need a new jersey?

YESNO

Please select a Jersey size and if a new hat is needed:For Returning Players

Jersey Size

Is a new hat needed?

Player (check all that apply)

Uses a wheelchair

Wears glasses

Uses a walker

Wears hearing aids

Uses crutches

Has seizures

Other

Please list any medication player takes:

Medication 1

Medication 2

Medication 3

Medication 4

Medication 5

Medication 6

Please list any allergies player has:

Allergies 1

Allergies 2

Allergies 3

Allergies 4

Allergies 5

Allergies 6

Emergency Contact 1* This field is required.

Name:

Phone Number

Relationship

Emergency Contact 2

Name:

Phone Number

Relationship

Player is insured by:

My child {playerName} is insured by the following company: {playerIs} and has my permission to participate in the Roger N. Allen Baseball program under the supervision of the assigned coaches. In giving this consent, I do so with full understanding that the Roger N. Allen Baseball League and its staff assumes no financial liability for any accident or injury to my child, which may occur as a result of his/her participation in the program. I agree to hold Roger N. Allen Baseball harmless against any and every obligation, liability, and responsibility for damage to persons or property occurring during any league play and/or special event. I understand that my child's likeness may be used for promotional/media purposes such as league websites, fliers, advertisements, commercials, newspapers, and TV news, etc….

Parent 1 Signature* This field is required.

Clear

Parent 1 Name* This field is required.

First Name

Last Name

Date* This field is required.

Date

Parent 2 Signature

Clear

Parent 2 Name

First Name

Last Name

Date

Medical Release & Parent/Guardian Authorization
In case of an emergency, if the family physician cannot be reached, I hereby authorize my child (player name): {playerName} (Date of birth): {birthday} to be treated by another qualified, licensed physician who is available.

Family Physician: * This field is required.

Physician Name

Physician phone number

Family Physician Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Parent 1 Signature* This field is required.

Clear

Parent 1 Name* This field is required.

First Name

Last Name

Date* This field is required.

Date

Parent 2 Signature

Clear

Parent 2 Name

First Name

Last Name

Date

We need your help!!!In which of the following area(s) suit you best?

Manager

Coach

League Officer

Facilities

Team Mom/Dad