Name: ____________________________
Address:_____________________ Ph# ________________
City/State: ________________________________ Zip ________
Allergies/Health Problems: _____________________________
_____________________________________________________
Grade ___ Birth Date: ____________ Hgt: _____
Wgt: _____
Most recent baseball experience: ________________________
Positions played: ______________________________________
Pitching experince? Y N
Catching experience? Y N
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TO WHOM IT MAY CONCERN: This is to certify that as the parent or guardian of (player's name)_______________________________________
Signed ___________________________________________ Date _______________ Relationship _______________________________________ Insurance Company ____________________________________________________ Policy or Certificate Number _____________________________________________
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