Wallkill Valley Recreation Softball Registration Form (Grades 3-8 Personal Helmets strongly suggested) Player Information First Name: Last Name: Today’s Date: Address: Date of Birth: City: State: Age: New Jersey Zip: Grade (during the season): School: Rookies (Grades K-2) Uniform Shirt Size: YS (6-8) YM (10-12) (Uniform Consists of Shirt, Socks, Hat) YL (14-16) Grades 3-8 Uniform Sizes (Consists of Shirt, Shorts, Socks, Hat) Adult Small Adult Medium Adult Large Photo Release: I herby authorize the use of my child’s photo for publicity purposes Signature:_______________________________ Adult X-Large Prefer Same Coach: Yes Previous Coach: Did the player participate last season? Yes No No Volunteer Information *Volunteer coaches and assistants are always needed* Name Coach Assistant Phone Number Comments Other Primary Guardian Contact Information (Who will the coach/league contact) Name: Home: Cell: Email: Emergency Contact Information (If the primary guardian is unreachable) Name: Home: Cell: Insurance Information & Medical Release (Write on back if more space needed) Medical Insurance Provider: Policy Number: Physician: Phone Number: Known Allergies: The above applicant is in good physical and mental condition and requests enrollment in the Wallkill Valley Rec Softball Program. I/We, the parents or guardians of the above named child hereby give my/our approval to his/her participation in the Wallkill Valley Rec Softball program. I/We assume all risks and hazards incident to such participation. I/We realize there is a risk of injury to children playing/participating in softball activities/sports, and I/we do hereby release, absolve, indemnify and agree to hold harmless the Wallkill Valley Rec Softball League, directors, coaches, officers, trustees, instructors, sponsors, commissioners, participants and persons supervising and/or coaching my/our child. Print Name: Signature: Date: Payment Information $45 (Grades K-2) $60 (Grades 3-8 NO UNIFORM INCLUDED) $75 (Grades 3-8 UNIFORM INCLUDED) Registration paperwork and payments due no later than March 1st Grades 3-8 if played last year what was your uniform number: (Players uniform numbers stay with them until they leave the league) Cash Check Check Number Name On Check PLEASE PROVIDE A COPY OF YOUR CHILDS BIRTH CERTIFICATE AT REGISTRATION Make Check or Money Order Payable to: WVGS REC Mail Registrations to: Wallkill Valley Recreation Softball PO Box 129 Franklin NJ 07416