Eastvale Little League Registration

Player Information

First Name:   Last Name:

Date of Birth: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993

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Address:

City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code:

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Primary Phone: Primary Email:

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School: Adams Elementary Clara Barton Elementary Corona Ranch Elementary Eastvale Elementary Harada Elementary Highland Elementary Lincoln Alternative Elementary Ontario Christian River Heights Intermediate Roosevelt High Rosa Parks Elementary VanderMolen Elementary Home Schooled Not Listed Grade: Pre-Kindergarten Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade

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Player Lives With: Mother Father Both

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Returning Player: No Yes Last Spring Division: T-Ball Rookie T-Ball Single A Double A Triple A Major Junior Senior Team:

Select Division

T-Ball Age must be between 4 and 5 as of 4/30/2012	$120
Rookie T-Ball Age must be between 4 and 6 as of 4/30/2012	$120
Single A Age must be between 6 and 7 as of 4/30/2012	$120
Double A Age must be between 7 and 9 as of 4/30/2012	$140
Triple A Age must be between 9 and 11 as of 4/30/2012	$140
Major (no longer available) Age must be between 10 and 12 as of 4/30/2012	$140
Junior Age must be between 12 and 14 as of 4/30/2012	$150
Senior Age must be between 13 and 16 as of 4/30/2012	$150

 Fundraiser Buyout ($30)

Father/Legal Guardian

First Name:   Last Name:

Cell Phone:   Email:

Would you like to Volunteer? No Manager Asst. Coach Team Parent

Mother/Legal Guardian

First Name:   Last Name:

Cell Phone:   Email:

Would you like to Volunteer? No Manager Asst. Coach Team Parent

Medical Information

Insurance Carrier:   Policy/Member Number:

Doctor's Name:   Doctor's Phone:

Please indicate any physical limitiations (allergies, hearing, sight, etc.):

Emergency Contact (other than parent)

First Name:   Last Name:

Phone:   Relationship to Player:

Special Requests

Terms and Conditions

I/WE Accept the Terms and Conditions.  Click here to view Terms and Conditions