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