HERNDON/RESTON BABE RUTH

SUMMER 2005 SANDLOT REGISTRATION FORM

 
PLAYER INFORMATION:

 

          Name: _______________________________________  ____/__/___

                           First                                          MI              Last                                     Date of Birth

 

          Address: _______________________________________________

                                                Street                                  Town                                        Zip

          Parents/

          Guardians: _____________________________________________

                                                                 First                          Last                    Phone (H)              Phone (C)

 

____________________________________________             First                           Last                       Phone (H)              Phone (C)                                

 

 

Where did you play this spring season:

 
Circle one:      Cal Ripken     Little League      Babe Ruth

FEE:           $20    (make check out to HOBRB)

LIABILITY WAIVER AND RELEASE

          As the parent (or Legal Guardian) of the above-named minor, I grant permission for this minor to participate in all activities.  I assume all risks and hazards incidental to such participation, including transportation, and do hereby release and waive all claims against the Herndon Optimist Babe Ruth Baseball League, Herndon Optimist Club, sponsors, volunteers, agents, and other participants.  I further grant permission for emergency first aide to be given to my child.

________________________________________ ___________________

          Signature of Parent/Guardian                                                         Date

         

Mail form to:

Herndon Optimist Babe Ruth Baseball League
P.O. Box 1771
Herndon, VA 20172