Parent Name *

First Name

Last Name

Parent phone number *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Player Name *

First Name

Last Name

Player birth date *

MM

DD

YYYY

Player phone number

* For older age groups if player is completing this form

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What position(s) do you play?

Pitcher

Catcher

First Base

Second Base

Shortstop

Third Base

Outfield