GRAND SLAM FALL SOFTBALL

LEAGUE REGISTRATION FORM

NAME _______________________________________________________________

ADDRESS ____________________________________________________________

CITY __________________________  STATE_________   ZIP _________________

PHONE Home _________  (Parent's Name) _________Emergency Phone ________

AGE _________  PRESENT GRADE _______ SCHOOL _____________________

DIVISIONS OF PLAY: (Circle one) 8U       10U        12U        14U        16U        18U

REQUIRED BEFORE PLAY                      

HEALTH INS. CO. __________________________  POLICY # _____________

PHYSICIAN ________________________________________________________

            I hereby authorize the staff of Grand Slam USA, coach, and league officials to act for me, according to their best judgement, in any medical emergency and I hereby waive and release said persons form any liability for illness or injury incurred while attending any activities in association with Grand Slam USA's Fall Softball League.  I certify I am in good health and can participate without restriction.

Player's signature _______________________________  Date ________________

Parent's signature _______________________________  Date ________________

T-Shirt Size                 Adult Sizes                  S          M        L          XL

Team Name __________________________    Primary Position ________________

Coach Name ________________________       Secondary Position _______________

I would like to be on a team with ___________________________________________

Grand Slam

5079 Westerville Rd.

Columbus, OH 43231

(614)890-7526

FAX: (614)823-1966