2018 Miracle League of Northampton County Player Registration
Players First Name: *
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Player's Last Name: *
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Male or Female? *
Date of Birth (mo/day/year *
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Current Age: *
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Parent / Guardian First Name: *
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Parent / Guardian Last Name: *
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Home Phone Number: *
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Email Address: *
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Street Address: *
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City: *
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State: *
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Zip Code: *
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Municipality Living In (City, Borough, Township) *
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Disability: *
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Any Special Needs or Requirements?
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If Player was on a Team in 2015 what was the team?
Shirt Size: *
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I'd like to join the Booster Club
Have you read the Release document on the Registration Page on the Web Site? *
Your child will not be able to participate in the MLNC program unless you have read and agreed to what is stated in the Release
Do you agree with what is stated in the Release Document *
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