PLAYER __________________________________________________ DATE OF BIRTH ___________________

ADDRESS ___________________________________________________________________________________

TELEPHONE ____________ (H) ____________ (W) ____________ (CELL) SCHOOL _____________________

E-MAIL ADDRESS ____________________________________________________________________________

I do hereby agree to play with any team to which I am assigned by League Officials and to properly care for the uniform and equipment provided for my use.

PLAYERS SIGNATURE ___________________________________________________

I, parent/guardian of (player’s name) ___________________________________, hereby give approval for participation in any and all PONY BASEBALL, Inc. league activities. I hereby grant permission to managing personnel or other league representatives to authorize and obtain medical care from any licensed physician, hospital, or medical clinic should the player become ill or injured while participating in league activities away from home, or when neither parent or legal guardian is available to grant authorization for emergency treatment. I assume all risks and hazards incidental to such participation, including transportation to and from the activities; and do hereby waive, release, absolve, indemnify and agree to hold harmless the local league organization, PONY BASEBALL, Inc., the organizers, sponsors, supervisors, participants and persons transporting the player to and from activities, for any claim arising out of an injury to the player.

I further agree to furnish a birth certificate for the player upon request of league officials, and to return upon request the uniform and other equipment issued to the player in as good a condition as when received, except for normal wear and tear in league activities.

Accident insurance for this player is provided by:

_______________________________________________ ___________________________________________

(Insurance Company) (Policy or Certificate #)

_______________________________________________ ______________________ ______________

Signature of parent or legal guardian Relationship Date

If interested in volunteering to help the league in any of the following areas please check the boxes below: