2017 Challenger Division Little League Registration
















Experience:

Shirt Size: Youth   Or   Adult

Buddy  A) B)
C)



Photo Release

I hereby give the Challenger Little League the absolute and irrevocable right and permission, with respect to the
photographs that have been taken of me or in which I may be included with others:

a.

To use, re-use, publish, and re-publish the same, in whole or part, individually, or in conjunction with other
photographs, in any medium and for any purpose whatsoever, including (but not by way of limitation) illustration,
promotion and advertising and trade, television and multimedia, AND

b. To use my name in conjunction therewith if the Challenger Little League chooses.

I hereby release and discharge Challenger Little League , and third parties collaborating with Challenger Little League
from any and all claims in connection to photo reproductions of me and/or my narrative account of my experience
Challenger Little League as described herein.

(child’s name). For the consideration contained herein, I hereby consent to the foregoing on behalf of my child.

Registration Fee $30 (scholarships available)
Return Completed form and fee to:

(Checks payable to Challenger Little League)

Challenger Little League, P.O. Box 1448, Portage, MI 49081-1448
Please leave a message with questions @ (269)271-9100

Messages will be checked every couple days.

Registration closes February 15

Little League Medical Release

NOTE: To be carried by any Regular Season or Tournament
Team Manager together with team roster or International Tournament affidavit.











In case of emergency, if family physician cannot be reached, I hereby authorize my child to be treated by Certified
Emergency Personnel. (i.e. EMT, First Responder, E.R. Physician)









If parent(s)/legal guardian cannot be reached in case of emergency, contact:






       Please list any allergies/medical problems, including those requiring maintenance medication. (i.e. Diabetic, Asthma, Seizure Disorder)
Medical Diagnosis Medication Dosage Frequency of Dosage



The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.


WARNING: PROTECTIVE EQUIPMENT CANNOT PREVENT ALL INJURIES A PLAYER MIGHT RECEIVE WHILE PARTICIPATING IN BASEBALL/SOFTBALL.
Little League does not limit participation in its activities on the basis of disability, race, color, creed, national origin, gender, sexual preference or religious preference.

All fields marked with an "*" are required.



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