The Miracle League of Green Bay Summer 2023 REGISTRATION PLAYER INFORMATION
                                                                                                                       Black background items are mandatory!       
   For additional information please call:   920-615-6609                                               Deadline to register: April 1, 2023                        
   Fees per Athlete is $45.00                                                                                         email:
grogaczewski@new.rr.com
Note:
We strongly encourage that all parents sign up as substitute buddies in case they are needed; this will avoid last minute registration.
First Name Last Name
Street Address City State Zip

(#1)
Parent or
Guardian
E-Mail Phone Number(s)
Full Name
Primary 
reenter   
Secondary 
Evening #        
Day/Work # 
Mobile #       
(#2)
Parent or
Guardian
E-Mail Phone Number(s)
Full Name

Home # 
Work#  
Cell #    
Player's Gender Birthday (mm/dd/yyyy)
i.e. 06/19/1988
Age School
Male
Female
Diagnosis

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Special Needs or Requirements

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Wheelchair Walker Other
Which type of Buddy would be best for your child? (Check One)
Adult
Older Child
Sibling
Parent
Player Shirt Size (Check One)  
Youth Adult
Small
Medium
Large
Small
Medium
Large
Extra Large
XX Large
XXX Large

Comments (i.e. Buddy Request, Buddy Needs, etc.)

255 characters remaining.


In consideration for the Miracle League of Green Bay providing the opportunity for my child to participate in Miracle League baseball, the undersigned does hereby release and agree to indemnify and hold harmless the Miracle League of Green Bay and its officers and directors from any and all claims for personal injury, death, property damage, or any type of claim or damage (including but not limited to, attorney’s fees or litigation expenses) resulting from my child’s activities in connection with participation in Miracle League baseball or participation of any family member or guest of the undersigned. 

I/We agree to be present at all games and activities (unless a parental delegation form has been signed and approved) so that I/We can manage our child’s specific needs. I agree to have any and all medication (prescription and non-prescription) for my child and shall be solely responsible for dispensing any such medication to my child. 

I/We understand that there will be media and promotional coverage of Miracle League Games and activities and I/We give our consent to publish my/our child’s name and picture for such purposes. I hereby grant the Miracle League of Green Bay and/or Association, its affiliates, franchises, advertising and promotional agencies, and their agents, the irrevocable, unrestricted right to use, publish, display and distribute materials bearing my name, voice, likeness, or any other identifiable representation of myself, my family members, including my Miracle League player/child. These materials may appear in any form, style, color, or medium whatsoever (including without limitation, photographs, video tapes, films, sound recordings, software, drawings, prints, broadcast, internet, and electronic media). I agree that all material containing identifiable representation of me (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 Association. I hereby release and forever discharge The Miracle League Association from any and all liability and damages relating to my name, voice, likeness or any identifiable representation of me. I hereby waive any right I may have to inspect or approve the finished materials or any part or element thereof that incorporates my name, voice, likeness or any other identifiable representation of myself, my family, including my Miracle League player/child. I have agreed to the above in consideration of the opportunity given to me by the Miracle League Association to appear in these materials.


  By checking here, I/We agree to all terms stated above