The Miracle League of Green Bay Summer 2019 REGISTRATION PLAYER INFORMATION
                                                                                                                       Black background items are mandatory!       
   For additional information please call:   920-615-6609                                               Deadline to register: April 1, 2019                        
   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.)

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