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 ___ Umpire ___ Field Maintenance ___ Concession Stand ___ Uniform distribution Second Parent/Guardian: ____________________________ phone: _______________ Email: ______________________________ How I would like to help (check one or more) ___ Coach ___ Assistant Coach ___ Umpire ___ Field Maintenance ___ Concession Stand ___ 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 ___ Check here to donate $20

Mail to: Richmond Area Little League PO Box 19 Richmond, VT 05477