Rochester Girls Softball 2010

Tball: $20 per player plus fundraiser

All other Leagues (no fundraiser): $60 single player, $80 two players, $90 more than two players

Players Name: _______________________________________Date of Birth:_______________Age:_____

*To be eligible to participate, girls must be at least 4 yrs old on January 1, 2010*

If you played last year: League:_____________________________ Team__________________________

(senior, junior, minor or tball)

Parents Name:___________________________________________________________________________

Address:________________________________________________________________________________

Phone1:______________________________Phone2:____________________________________________

I hereby give consent for my daughter, _________________________________________ to participate in Rochester Girls Softball during the summer of 2010.

__________________________________________(Parent signature)

MEDICAL CONSENT

I, being the parent and/or legal guardian of _______________________________, do hereby give permission to the Rochester Girls Softball League to secure whatever emergency medical services and/or medical examination deemed necessary by the staff of the Rochester Girls Softball League and/or licensed medical doctors. This shall include but not be limited to surgical, dental, optical, neurological or emergency needs. This form shall give authorization for all medical needs whether emergency, routine or diagnostic.

Signature____________________________________________________ Date______________________

List all Medications (name & dosage):

Allergies or medical conditions:

Shirt Size – Circle One Youth: M L Adult: S M L XL

Please return this form along with your payment by March 1^st to:

Rochester Girls Softball

c/o DeBruler Imaging

808 Main Street Rochester, IN 46975