EATON RURITAN COMMUNITY PARK
Knee-High T-Ball • T-Ball • Coach Pitch • Fast Pitch • Softball Program
www.eatonruritan.com

NAME: (LAST)________________________  (FIRST)_____________________  (MIDDLE)_________________

ADDRESS:__________________________________________________________________________________

CONTACT PARENT NAME:____________________________________________________________________

DOES CHILD HAVE ANY MEDICAL PROBLEMS OR REQUIRE ANY MEDICATION THAT HIS/HER COACH SHOULD BE AWARE OF?  ___ YES ___ NO   IF YES, PLEASE NOTE:
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AGE NOW ____ DATE OF BIRTH (MONTH) ____ (DAY) ____ (YEAR) ______

DID HE/SHE PLAY AT EATON PARK LAST YEAR? ____ YES ____ NO

IF YES, WHOSE TEAM WAS HE/SHE ON? ___________________________

DOES HE/SHE HAVE ANY BROTHERS OR SISTERS PLAYING? ____ YES ____ NO
IF YES, LIST THEIR NAME(S), AGE NOW, AND WHOSE TEAM THEY WERE ON:
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THIS IS TO CERTIFY THAT THE ABOVE NAMED CHILD HAS PERMISSION TO PARTICIPATE IN THE RURITAN COMMUNITY PARK T-BALL/SOFTBALL/BASEBALL PROGRAM.  IT IS UNDERSTOOD THAT 
I/WE THE PARENT(S) OR GUARDIAN(S) ARE RESPONSIBLE FOR INSURANCE FOR THE CHILD PARTICIPATING AND THAT THE RURITAN PARK IS NOT RESPONSIBLE FOR ANY INJURIES INCURRED.

IF A CHILD'S AGE IS IN QUESTION, A BIRTH CERTIFICATE OR PROOF OF AGE MAY BE REQUESTED.

PARENT OR GUARDIAN'S SIGNATURE________________________________________
RELATIONSHIP TO CHILD___________________________________________________

AS PARENT/GUARDIAN OF THE ABOVE NAMED PLAYER, I WOULD BE WILLING TO VOLUNTEER 
TIME AS:  ____ COACH OR ASST. COACH  ____ CONCESSION STAND WORKER
 ____ CLEAN-UP WORKER ____ OTHER: MOW, CARPENTER, PAINTER, ETC.

REGISTRAR