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MOLINE CHALLENGER LEAGUE
APPLICATION TO PLAY LITTLE LEAGUE CHALLENGER DIVISION – 2012
(Please print)
Player’s name:_______________________________________________Date of Birth:___________________
Address___________________________________________________________________________________
City:__________________________________________ State:___________ Zip:____________________
Home Phone:_______________________________ ____ Cell Phone:________________________________
E-mail Address:__________________________________________________________________________________
Parent/Guardian:____________________________________________________________________________
(Name) (Relationship) (Phone #)
Emergency Contact:_______________________________________________________________________________
(Name) (Relationship) (Phone #)
Please check one: New Player:________ Returning Player:________
I/We, the parents/guardian of the above named player candidate, give my/our approval for his/her participation in all Little League activities and transportation to and from the activities. I/We know that participation in baseball may result in injury and that protective equipment does not prevent all injuries to players and do hereby waive, release, absolve, indemnify and agree to hold harmless the local Little League, Little League Inc, the organizers, sponsors, supervisors, participants, and person transporting my/our player, whether the result of negligence or any other cause, except to the extent and in the amount covered by accident or liability insurance.
I/We agree to return any equipment issued to my/our player in good or fair condition, and I/We agree to follow the helmet rule established by the league.
Parent(s) or Guardian Signature:________________________________________________________________________________________________
Please indicate any physical limitations (allergies, hearing, vision etc.):__________________________________________________________________________________________________
Accident insurance:__________________________________________________________________________
The Challenger League Board has decided to go with ONE cap for all players, regardless of team. It is a gray cap with a navy blue bill and it will have “Moline Challenger League” on the cap. It is not a requirement that each player have this new cap, but wanted to give everyone the opportunity to purchase one if they wish to do so.
Registration and play (use shirt and cap from previous year) $10.00
Registration, play, and a new shirt – see size below $15.00
Registration, play, and a new cap – see size below $15.00
Registration, play, a new shirt, and a new cap – see sizes below $20.00
If the fee would be a hardship, please contact Pam Swim. NO player will be denied the opportunity to play baseball.
Shirt size (circle ONE, if needed): Youth Small Youth Medium Youth Large
Adult Small Adult Medium Adult Large Adult XL Adult XXL
Cap size (circle ONE, if needed): Youth Adult
Pop/beverage sign up, which date would work best for you:_________________________________________
You may include payment for the ADA game at Modern Woodmen Park, the River Bandits vs. Peoria. The Challenger League player gets in free; everyone else is $8 each. Please specify if you need a wheelchair spot.
Please return signed form, with payment, by March 31, 2011
To save on costs, we have e-mailed this to all that we have your e-mail address. PLEASE reply to Pam or Jan that you have received this e-mail, otherwise we will mail you the forms.
(Please print)
Player’s name:_______________________________________________Date of Birth:___________________
Address___________________________________________________________________________________
City:__________________________________________ State:___________ Zip:____________________
Home Phone:_______________________________ ____ Cell Phone:________________________________
E-mail Address:__________________________________________________________________________________
Parent/Guardian:____________________________________________________________________________
(Name) (Relationship) (Phone #)
Emergency Contact:_______________________________________________________________________________
(Name) (Relationship) (Phone #)
Please check one: New Player:________ Returning Player:________
I/We, the parents/guardian of the above named player candidate, give my/our approval for his/her participation in all Little League activities and transportation to and from the activities. I/We know that participation in baseball may result in injury and that protective equipment does not prevent all injuries to players and do hereby waive, release, absolve, indemnify and agree to hold harmless the local Little League, Little League Inc, the organizers, sponsors, supervisors, participants, and person transporting my/our player, whether the result of negligence or any other cause, except to the extent and in the amount covered by accident or liability insurance.
I/We agree to return any equipment issued to my/our player in good or fair condition, and I/We agree to follow the helmet rule established by the league.
Parent(s) or Guardian Signature:________________________________________________________________________________________________
Please indicate any physical limitations (allergies, hearing, vision etc.):__________________________________________________________________________________________________
Accident insurance:__________________________________________________________________________
The Challenger League Board has decided to go with ONE cap for all players, regardless of team. It is a gray cap with a navy blue bill and it will have “Moline Challenger League” on the cap. It is not a requirement that each player have this new cap, but wanted to give everyone the opportunity to purchase one if they wish to do so.
Registration and play (use shirt and cap from previous year) $10.00
Registration, play, and a new shirt – see size below $15.00
Registration, play, and a new cap – see size below $15.00
Registration, play, a new shirt, and a new cap – see sizes below $20.00
If the fee would be a hardship, please contact Pam Swim. NO player will be denied the opportunity to play baseball.
Shirt size (circle ONE, if needed): Youth Small Youth Medium Youth Large
Adult Small Adult Medium Adult Large Adult XL Adult XXL
Cap size (circle ONE, if needed): Youth Adult
Pop/beverage sign up, which date would work best for you:_________________________________________
You may include payment for the ADA game at Modern Woodmen Park, the River Bandits vs. Peoria. The Challenger League player gets in free; everyone else is $8 each. Please specify if you need a wheelchair spot.
Please return signed form, with payment, by March 31, 2011
To save on costs, we have e-mailed this to all that we have your e-mail address. PLEASE reply to Pam or Jan that you have received this e-mail, otherwise we will mail you the forms.