Player Information

First Name *

Last Name *

Parent/Guardian Name *

Address 1 *

Address 2

City *

State *

Postal Code *

Phone *

Cell Phone

Email Address *

Birthdate *

Age *

Gender *

Male

Female

Diagnosis

Special Needs or Requirements

School

Grade

Hobbies

Emergency Contact Name & Number *

Emergency Contact Address *

Shirt Size *

Hat Size *

Youth

Adult

Policy: You give authorization for you child to participate in the Miracle League/Champions Adaptive League and do hereby release of any liability for injury that may occur while participating as a player or spectator during the season. Parent and/or guardian must be present at all games and/or events. You hereby grant The Miracle League, its affiliates, franchises, advertising, and promotional agencies, and their agents, the irrevocable, unrestricted right to use, publish, display, and distribute materials bearing your name, voice, likeness or any other identifiable representation of yourself, your family, including your Miracle League player/child. These materials may appear in any form, style, color, or medium whatsoever (including, without limitation, photographs, video tapes, film sound recordings, software, drawings, prints, broadcast, internet and electronic media). You agree that all material containing any identifiable representation of you (including without limitation, all negatives, plates, and masters of any photographs, files, prints, or tapes) shall be and remain the sole and exclusive property of the Miracle League. You hereby release and forever discharge the Miracle League from any and all liability and damages relating to the use of your name, voice, likeness, or any other identifiable representation of you. I hereby waive any right I may have to inspect or approve the finished materials or any part or element thereof that incorporates your name, voice, likeness, or any other identifiable representations of yourself, your family, including your Miracle League child. You have agreed to the above in consideration of the opportunity given to you by the Miracle League to appear in these materials. You acknowledge that you have fully read and understand this document and that you have had any questions regarding its effect of the meaning of its terms answered to your satisfaction. You certify that you are 18 yrs old age.

PROFANITY/BULLYING POLICY: The Miracle League will not tolerate the use of profanity by players. The Miracle League also will not tolerate players bullying other players or volunteers. Players will be given one verbal warning during your game and if you use profanity or disrespect toward other players/volunteers again you will be asked to leave the game. If this happens 3 times during the season you will not be able to return until next year. This is up to the discretion of your coach. Please sign below that you understand and will not use profanity and will continue to treat others the way you want to be treated. Thanks for understanding in this matter!

By clicking "I agree" you are stating that you understand and agree to the above statements. *

I agree

Youth S	Youth M	Youth L
Youth XL	Adult S	Adult M
Adult L	Adult XL	Adult 2X
Adult 3X