Online Registration

First Name

Last Name

Date of Birth (MM/DD/YYYY)

Street Address

City, State, Zip

,

Mother's Full Name

Alt. Phone Number

Fathers's Full Name

Alt. Phone Number

Email Address

Who has custody of player?

 Mother Father Both

Who does the player live with?

 Mother Father Both

Does the player live at the same address as parent(s) who have custody?

 Yes, Mother Yes, Father Yes, Both

Would you be interested in...

 Coaching Sponsoring a team Joining a committee (opening day, end of the year party, etc.)

Person to call if parent/guardian cannot be reached

Phone Number

Relation to Player

Is player allergic to any medications? If so, what?

Division (based on player age as of January 1, 2010)

---Instructional (Ages 4-6)Pigtail (Ages 7-9)Ponytail (Ages 10-12)Majors (Ages 13-19)

Team Selection

 Did not play in Eastlake last year Played last year and wishes to return to same team Played last year and wishes NOT to return to same team

Team

Coach

Disclaimer: You can request to be on the same team and we will try to accommodate all requests but they cannot be guaranteed.

Shirt Size

---YSYMYLSMLXLXXL

Short Size

---YSYMYLSMLXLXXL

Please Read and Sign Below

In case of medical emergency, I give the coaches/supervisors of Eastlake Girls Softball, Inc. permission to call the paramedics to treat and/or transport me/my child to the nearest hospital for necessary treatment. In consideration of me/my child participating in the recreation program of the City of Eastlake and Eastlake Girls Softball, Inc., I hereby waive and relinquish any and all claims, and demands and/or causes of action against the City of Eastlake, its employees, agents and all personnel associated with the recreation program of the City of Eastlake and Eastlake Girls Softball, Inc. I further waive all claims, demands and/or cause of action, as stated above, against any person(s) transporting me/my child to any league or league-associated activity. In case of monetary judgment awarded to me as a result of participation in Eastlake Girls Softball, Inc., I hereby agree to reimburse the City of Eastlake and Eastlake Girls Softball, Inc., of any monetary award, which may be determined concerning claims as a result of participating in Eastlake Girls Softball, Inc. I also understand that the City of Eastlake and Eastlake Girls Softball, Inc. do not carry medical insurance on participants or spectators and that it is the responsibility of each individual to secure the insurance if desired.

I have read the foregoing, understand it and voluntarily agree