2011 Leominster Babe Ruth Baseball League   Player Registration Form                           The registration deposit is non-refundable if the player is chosen for a team.                             If a player does not make a team money will be refunded and the player will be put on the waiting list                       Player Information: (Please complete all information.)                                 Name             Date of birth                             Address             Home phone                             City         State   Zip code                             Parent/Guardian Information: (Please complete all information.)                               Father/Male Guardian Name                                       Phones: Home/Work/Cell (H)   (W)   (C)                             Employer           Occupation                               Mother/Female Guardian Name                                       Phones: Home/Work/Cell (H)   (W)   (C)                             Employer           Occupation                               Player Medical Information: (Please complete all information.)                               Insurance Carrier           Policy no.                             Primary Physician           Phone no.       List all allergies to medications:                                                           List all medical conditions:                                                             List all medicines the player is required to carry (inhalers, bee sting kits, etc.):                                                                         Email Address:___________________________________________________________________________                         There will be some type of Fundraiser to help defray the cost of registration. The concession buy out will will be part of the fundraiser.  Fee for 2011 is $200.  Which a $100 deposit is needed.  No player will play until the second deposit is put down which is due by April 1st.                                                   Parent/Guardian Signature           Date     For League use only     Paid $     Check #     Cash