FWM Little League Sign Up Form: Ball Player
FWM Little League Sign Up Form: Ball Player
FEE: $45.00 FOR THE FIRST CHILD AND $20.00 FOR EACH ADDITIONAL CHILD
PLEASE NOTE
As of 2015, Little League, Inc., regulations were updated which now allow us to accept players who
live outside our charter area but who attend Mehoopany Elementary School. This includes
Washington Park & Westgate areas.
Ball Player
PLAYERS NAME: ____________________________________ BOY or GIRL
ADDRESS:
____________________________________
TOWNSHIP:
____________________________________ ZIP CODE: ____________
PHONE NUMBER: ____________________________________
DATE OF BIRTH: ____________________________________
BASEBALL AGE AS OF 12/31/2015
___________________
SOFTBALL AGE AS OF 12/31/2014
___________________
T-BALL AGE AS OF 12/31/2015
___________________
PARENTS/GUARDIANS
FATHERS NAME: _______________________________________
ADDRESS:
_____________________________________________________
TOWNSHIP:
SAME AS ABOVE
PHONE NUMBERS:
HOME: ___________________ WORK: ____________________ CELL: ___________________
EMAIL: __________________________________________________
MOTHERS NAME: _______________________________________
ADDRESS:
_____________________________________________________
TOWNSHIP:
SAME AS ABOVE
PHONE NUMBERS:
HOME: ___________________ WORK: ____________________ CELL: ___________________
EMAIL:___________________________________________________
Would you like to be a coach or volunteer to help in some capacity this year?
TEAM: ___________________________________________
Please send the completed forms before February 18, 2015 to:
FWM Little League
P.O. Box 51
Mehoopany, PA. 18629
_______________
INSURANCE INFORMATION
FAMILY PHYSICIAN: ____________________________________________________
ADDRESS:
____________________________________________________
PHONE NUMBER:
____________________________________________________
IN CASE OF AN EMERGENCY CONTACT:
NAME
PHONE
RELATIONSHIP TO PLAYER
NAME
PHONE
RELATIONSHIP TO PLAYER
Please list any allergies/medical problems the coach needs to be aware of (optional): ____________________
DIVISION OF PLAY
PLEASE MARK WHAT DIVISION YOU WOULD LIKE TO PLAY IN
________ T-BALL (4-8)
________ BOYS & GIRLS INTRUCTIONAL*(6-8)
________ MINOR BASEBALL (7 - 12)
________ MINOR SOFTBALL (7 - 12)
________ MAJOR BASEBALL (9 - 12)
________ MAJOR SOFTBALL (9 12)
________ JUNIOR BASEBALL (1314)
________ JUNIOR SOFTBALL (13 -14)
________ SENIOR BASEBALL (15-16)
________ SENIOR SOFTBALL (1516)
________ BIG LEAGUE BASEBALL (17-18)
________ BIG LEAGUE SOFTBALL (17-18)
*6 year olds must have one year of t-ball experience.
UNIFORM INFO:
SHIRT SIZE:
YS 6/8 YM 10/12
YL 14/16
AS
AM
AL
DATE