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Player Registration Form
Complete the Player Registration Form below and submit to register your player with Moody Miracle Field.  If you have any questions, please email moodymiracleleague@gmail.com or call 205.225.9444.
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First Name *
Last Name *
Birthdate *
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Age *
Street Address 1 *
Street Address 2
City *
State *
Zip *
County *
Email
Diagnosis
Phone Number Type
Phone Number (Format: xxx-xxx-xxxx)
Jersey Size Category
Clear selection
Jersey Size *
Re-Enter Jersey Size (Example: Youth S)
Jersey Number *
Jersey Number Location *
Name on Jersey *
Location of Name *
Do you use a wheelchair when playing baseball? *
Parent/Guardians Name(s)
Indicate One
Clear selection
Best Way for Communication for event information/cancellation (check all that apply)
Walk Up Song Choice 1 (please choose from list)
Walk Up Song Choice 2 (please choose from list)
Favorite Food
Favorite Color
Other Sports
Hobbies
Nick Names
Pet Names
Favorite Job
Did you play last year?
Clear selection
If yes, what team did you play on?
Comments
Player Permission
I hereby grant the Miracle League Association, its affiliates, franchises, advertising and promotional agencies, and their agents the irrevocable, unrestricted rights to use, publish, display and distribute any materials bearing my voice, likeness or any other identifiable representation of myself, my family members, including my Miracle League player/child.  These materials may appear in any form, style, color or medium whatsoever (including, without limitation, photographs, video tapes, films, sound recordings, software, drawings, prints, broadcast, internet and electronic media).  I agree that all materials containing identifiable representation of me (including without limits, all negatives, plates and masters of any photographs, files, prints or tapes) shall be and remain the sole and exclusive property of the Miracle League Association.

I hereby release and forever discharge The Miracle League Association from any and all liability and damage relating to my name, voice, likeness or any identifiable representation of me.  I hereby waive any right I may have to inspect or approve the material or any part or element thereof that incorporates my name, likeness or any other identifiable representation of myself, my family, including my Miracle League player/child.  I have agreed to the above in consideration of the opportunity given to me by the Miracle League Association to appear in these materials.  I acknowledge that I have fully read and understand this document and that I have had any questions regarding its effect or the meaning of its terms answered to my satisfaction.  I certify that I am at least 18 years of age, unless my parent or guardian also signs this document.

I understand that I may be subject to a background check.

I understand that my electronic signature serves as an actual signature.
Applicant Signature *
Date
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Parent/Guardians Name(s)
Parent/Guardian Signature (If player is 18 or under)
Date
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Submit
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