FWM LITTLE LEAGUE SIGN UP FORM

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:

_______________________________________ ZIP CODE: ______________

SAME AS ABOVE

PHONE NUMBERS:
HOME: ___________________ WORK: ____________________ CELL: ___________________
EMAIL: __________________________________________________
MOTHERS NAME: _______________________________________
ADDRESS:

_____________________________________________________

TOWNSHIP:

_______________________________________ ZIP CODE: ______________

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

AXL (CIRCLE ONE)

NAME ON HAT: ____________________

_______________________________________________ HAS MY PERMISSION TO PARTISIPATE IN FWM LITTLE

LEAGUE ACTIVITIES.
I RELEASE ALL OFFICERS, MANAGERS, SPONSORS AND ALL OTHER
VOLUNTEERS OF DAMAGE RESULTING FROM ANY ACTIVITIES, INCLUDING TRANSPORTATION TO AND
FROM GAMES AND PRACTICES. I ASSUME ALL RISK AND HAZARDS INCIDENTAL TO CONDUCT OF THE
ACTIVITIES. I AGREE TO FURNISH A BIRTH CERTIFICATE TO PROVE PLAYERS AGE AS REQUIRED BY
THE FWM LITTLE LEAGUE.

SIGNATURE of PARENT or GUARDIAN

Please send the completed forms before February 18, 2015 to:
FWM Little League
P.O. Box 51
Mehoopany, PA. 18629

DATE