Lihue Baseball League

2015 Age Key
Mustang Age Under 5/1/2006 and 4/30/2007
Mustang Age 9 Between 05/01/2005 and 4/30/2006
Mustang Age 10 Between 5/1/2004 and 4/30/2005
Bronco Age 11 Between 5/01/2003 and 4/30/2004
Bronco Age 12 Between 5/1/2002 and 4/30/2003
Kaua’i Pony Baseball
P.O. Box 804 Lihue, HI 96766
www.kauaiponybaseball.com
Player Information
Sex
Date of Birth
League
Player’s Last Name
East Registration Fee $125
(Haena – Halfway Bridge)
Player’s First Name
Physical Address
City
M
1st Choice Mustang/Bronco
JerseyNumber
YS
YM
F
YL
YXL
AS
AM
AL
Cap
Zip Code
2nd Choice Mustang/Bronco
AXL
YS
Jersey
West Registration Fee $100
(Halfway Bridge – Mana)
YM
3rd Choice Mustang/Bronco
YL
YXL
AS
AM
AL AXL
Pants
Youth
Adult
Belt
One Size Fit Most
Socks
One Size Fits Most
List All Siblings Playing in Same Division (Mustang, Bronco or Pony)
Player’s Medical Conditions/Allergies
Parent / Guardian Information
PrimaryName
Secondary Name
PrimaryPhone 1
Secondary Phone 1
PrimaryPhone 2
Secondary Phone 2
PrimaryEmail
Secondary Email
In Case Of Emergency
Contact
Phone
PLEASE READ CAREFULLY
I/We the parent(s) or guardian(s) of the above-named applicant, give my/our approval to the applicant’s participation in any and all KAUAI PONY BASEBALL activities. I/We assume all risks
and hazards incidental to any participation, including transportation to and from the activities; and I/We waive, release, absolve, and agree to hold harmless KAUAI PONY BASEBALL, its Board of
Directors, managers, coaches, supervisors, and participantsfrom and againstanyliabilityfor any injury, whichmay be incurred by my/ourchildarising out of or in any wayconnectedwiththeir
participation in this program.
Medical Release: As a parent or guardian I give my approval for my child to participate in any and all PONY and/ or KAUAIPONYBASEBALL activities. I hereby grant permission to managing
personnel or other league representatives to authorize and obtain medical care from any licensed healthcare professional, hospital or medical clinic should the player become ill or injured while
participatingin leagueactivitiesawayfromhome, or whenneitherparentnor legal guardianis availableto grantauthorizationforemergencytreatment. I assumeallrisks and hazards incidental to
such participation, including transportation to and from activities; and do hereby waive release and absolve indemnify and agree to hold harmless the local league organizations, PONY BASEBALL,
KAUAI PONY BASEBALL, the organizers, sponsors, supervisors, participants and persons transporting the player to and from the activities, for any claim arising out of injury to the player. Photo/Media
Release:I grant permissionto KAUAIPONYBASEBALL and its agents or representatives, to usephotographs takenof my child for usein league publicationsand to use suchphotographsin
electronic versionsfor the KAUAIPONYBASEBALL website or other electronic forms or media, thepurpose being to share players’ experiences and to promotethe activities of theKAUAIPONY
BASEBALL.
I/We also understand that I/We are required to assist the league in order to have an active program for my/our child and will work in the food booth, assist with the fields and participate in the
fundraisersasrequired.
KAUAI PONY BASEBALL reserves the right to deny application, suspend and revoke parent and player privileges at any time. Please note: All registration fees must be paid; and a completed
andsigned applicationacceptedbeforemy/ourchildcanplay any seasongames.All unsignedor incompleteapplicationsWILLBE REJECTED,andmy/our childcannotparticipateuntil application
isaccepted. I/We understand that our child must reside within league boundaries and will provide proof if requested. II/We understand that my child needs to have medical insurance in order
toparticipateinleagueactivitiesand willprovideproofifrequested. I/Weunderstandthatpaymentto theleagueis NONREFUNDABLE,andthatan additionalservicecharge of$25.00 will be
collectedforallreturnedchecks.
Parent or Guardian’s Signature
Date
Relationship to Player