WARSAW LITTLE LEAGUE

2012 REGISTRATION FORM

REG. DATES:SUN, FEB 12, 2012 1 - 4 P.M. / SUN FEB 19, 2012 1 -4 P.M. / SUN, FEB 26, 2012 1 - 4 P.M. / SUN, FEB 27, 2011 1 - 4 P.M.

CENTER LAKE PAVILLION

LITTLE LEAGUE "OPENING NIGHT" IS SCHEDULED FOR FRIDAY, May 4, 2012

T-BALL & COACHES PITCH OPENING DAY WILL BE ANNOUNCED AT A LATER DATE

2011 SCHEDULE OF FEES & REGISTRATION GUIDELINES

T-BALL, COACHES PITCH, & BIG LEAGUE:

$40.00 PER CHILD

LITTLE LEAGUE & SENIOR LEAGUE:

$75.00 PER CHILD

A FAMILY CAP OF $130.00 WILL APPLY. LATE FEE: $10.00 PER PARTICIPANT WILL APPLY AFTER MARCH 1, 2011

To register by mail you must submit a completed and signed registration form for EACH child, attach a copy of a birth certificate for each child, and enclose a check or money order for the appropriate fee(s) made payable to the Warsaw Little League. Please mail this information to: THE WARSAW LITTLE LEAGUE, P.O. BOX 153, WARSAW, IN 46581-0153

INSURANCE DISCLAIMER & COVERAGE

I/We the parents of the below named candidate for a position on a Little League team, hereby give my approval to participate in any and all Little League activities, including transportation to and from activities.

I/We know that participating in baseball may result in serious injuries and that protective equipment does not prevent all injuries to players, and do hereby wave, release, absolve, indemnify and agree to hold harmless, Warsaw Little League, Little League Baseball Inc., the organizers, sponsors, supervisors, participants, and person transporting my/our child to and from actitvities for any claim arising out of injury to my/our child whether the results of negligence or for any other causes, except to the extent and in the amount covered by accident or liability insurance.

The Warsaw Little League provides insurance coverage to all players under Little League Baseball's blanket protection. Little League coverage will pay what your insurance company will not cover and there is a $50 deductible per event.

APPLICANT INFORMATION

ALL INFORMATION MUST BE COMPLETED (Please Print Legibly)

PARENTS MUST FURNISH A COPY OF ALL BIRTH CERTIFICATES TO LEAGUE OFFICIALS AT THE TIME OF REGISTRATION

PLAYERS NAME

BIRTHDATE (M/D/Y)

STREET ADDRESS

CITY

STATE

ZIP

PHONE NUMBER

E-MAIL ADDRESS

PLEASE LIST ALL PHYSICAL LIMITATIONS (ALLERGIES, HEARING, SIGHT, ETC.)

NAME OF FAMILY HOSPITALIZATION PLAN

SCHOOL

FULL NAME OF SIBLING IN SAME LEAGUE

NAME OF PARENT INTERESTED IN COACHING:

HEAD COACH

ASST. COACH

FATHER'S SIGNATURE

MOTHER'S SIGNATURE

DAYTIME PHONE #

HOME PHONE #

OTHER SPRING/SUMMER ACTIVITIES THAT PLAYER WILL PARTICIPATE IN DURING THE BASEBALL SEASON (SOCCER, TRACK, BASKETBALL, BAND, BASKETBALL

CAMPS, FOOTBALL CAMPS, TRAVEL BASEBALL, ETC.

OFFICIAL USE ONLY

T-BALL AGE

C-PITCH AGE

LITTLE LGE AGE

SENIOR LGE AGE

TB/CP SHIRT SIZE

BIRTH CERT

PITCHER CATCHER

POOL PLAY

PRIOR LEAGUE

SIBLING AGE

1ST 2ND SS 3RD

T-BALL MINOR MAJOR

5 6 7 8 9 10 11 12

4 5 6

7 8

8 9 10 11 12

13 14 15 16

YS YM YL

YES NO

LF CF RF

YES NO

SR. MINOR SENIOR BIG LGE

13 14 15 16 17

PLAYER UNIFORM NOTICE

The Player will expected to return their Jersey Shirt and Pants to their coach immediately following their last game of the season played. Failure to do so, will result in the League charging the parents or guardian $65 for the Jersey. The T-Ball/Coach Pitch T-Shirt and Cap may be kept by the participant at season's end.

This form can be found on our website at http://warsawlittleleague.com/