2016 Richmond Area Little League Player Registration Form

Baseball/Softball $50- Register by 4/2/16

Help us out! Register online at: http://richmondarealittleleague.com

Player Name: _________________________________ Grade: ________________

Birth Date:______________ Gender: M/F (circle)

School: ___________________

Did this child play in Richmond Area Little League last year? ___________
Shirt Size: Child: Small (6) Med (8) Large (10/12) Adult: S M L XL
Address: ___________________________________________________________
Primary Parent/Guardian: ___________________________ phone: _______________
Email: ______________________________
How I would like to help (check one or more)
___ Coach
___ Assistant Coach
___ Field Maintenance
___ Concession Stand

___ Umpire
___ Uniform distribution

Second Parent/Guardian: ____________________________ phone: _______________

Email: ______________________________
How I would like to help (check one or more)
___ Coach
___ Field Maintenance

___ Assistant Coach

___ Concession Stand

___ Umpire
___ Uniform distribution

Medical Information
Are there any medical conditions (allergies, medications, etc.) that Richmond Little League
should be aware of? ___ No

___ Yes

If yes, please explain: ___________________________________________________

____________________________________________________________________
Physician Name: _____________________________ phone # ____________________
Emergency Contact: __________________________ phone # ____________________
Parent/Guardian signature _______________________________ Date: ____________
Comments/requests: _____________________________________________________
Please include a check for $50 to Richmond Area Little League
Late Registration- if mailing after 4/2/16, please include $35 late fee for a total of $85
(this reflects the actual cost we incur when ordering late uniforms).
___ Check here to request financial assistance
Mail to: Richmond Area Little League
PO Box 19
Richmond, VT 05477

___ Check here to donate $20