ECLL Registration Packet 2012

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El Campo Little LeagueP.O. Box 586El Campo, Texas 77437

Dear Little League Parent,

It is time to organize for the 2011 season. Enclosed is the registration form for your child(ren). If your

child(ren) was in the program last year, you may register by mail. The deadline for registration will be January 31,2012. Please make any necessary changes on the enclosed form and sign it at the bottom of the page. Theregistration fee for 2011 will be $65.00 for all ages except Tee-Ball (5-6 year olds) Registration Fee for Tee-Ball

will be $50.00. If the players parent/guardian fails to register their child(ren) by the deadline,El Campo Little League can not guarantee the player will be placed on a team, however

once a player is drafted on a team refunds will not be available.Make your checks payable to: El Campo Little League

P.O. Box 586El Campo, Texas 77437

El Campo Little League will hold open registration at El Campo Little League Office. (204 N. WashingtonSt., across from Novaks meet market) on Saturday, January 7th between 10:00am and 12:30pm. We will have a 2

nd

registration on Wednesday, January 11th between 6:00pm and 8:00pm at the same location..Parents and other people need to volunteer in the program as Managers, Umpires, and Coaches. Please

complete the Volunteers Application and turn it in with the completed player registration.

Try outs for Pee Wee (7~8), American League (9~10), and National League (11~12) will be held at the ballpark on Saturday, February 18 (See schedule below).

Make up Tryouts will be on Monday February 20 starting at 6:00 pm (make up tryouts are for children whomissed Saturdays tryout only)

Try outs for Junior League and Girls Senior League will be Saturday March 31 only.

Your childs age is based on their age as of: Boys - April 30, 2012Girls Dec. 31, 2011

(If the Tryouts are Rained out or Canceled there will be no Makeup. We will conduct a Blind Draft)

We will need parents that can help during the tryouts so all volunteers are welcome!


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We will need parents that can help during the tryouts so all volunteers are welcome!


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Lile League Baseball and SoballM E D I C A L R E L E A S E

NOTE: To be carried by any Regular Season or Tournament

Team Manager together with team roster or eligibility adavit.

Player: _____________________________________ Date of Birth: ____________ Gender (M/F):_________________

Parent (s)/Guardian Name:_____________________________________ Relaonship:____________________________

Parent (s)/Guardian Name:_____________________________________ Relaonship:____________________________

Players Address:____________________________________ City:_______________ State/Country:________ Zip:______

Home Phone:_____________________ Work Phone:______________________ Mobile Phone:_____________________

PARENT OR GUARDIAN AUTHORIZATION:

In case of emergency, if family physician cannot be reached, I hereby authorize my child to be treated by CeredEmergency Personnel. (i.e. EMT, First Responder, E.R. Physician)

Family Physician: ____________________________________________ Phone: _________________________________

Address: __________________________________________ City:________________ State/Country:_________________

Hospital Preference: __________________________________________________________________________________

Parent Insurance Co:_________________________ Policy No.:__________________Group ID#:_____________________

League Insurance Co:_________________________ Policy No.:__________________League/Group ID#:______________

If parent(s)/guardian cannot be reached in case of emergency, contact:

___________________________________________________________________________________________________

Name Phone Relaonship to Player

___________________________________________________________________________________________________Name Phone Relaonship to Player


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Little League

Parent #1

Name

Phone

Email

( ) ( )

Occupation

Volunteer?Volunteer?

Parent #2

Name

Phone

Email

Occupation

Player Registration Form

Birth Certificate Proof of ResidencyEmergency contact

Medical Information

Phone

League Use Only

Player name

Address Birthdate

Email

Home phone ( )

Gender

League Age/Fee

My child willtryout for:

Baseball

Softball

Age Amount

Address 2

City/State/Zip

2012 El Campo

If checked, fill out "Volunteer Application" If checked, fill out "Volunteer Application"

Yes No Y N


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LocaL League use onLy:Backron chck compl by la ocr ________________________________

on ____________________________________________________________________

System)s) used for background check (minimum of one must be checked):

Sx Onr Rsry Crmnal Hsory Rcors *LxsNxs

*Please be advised that if you use LexisNexis and there is a name match in the few states where

only name match searches can be performed you should nofy volunteers that they will receive a

leer directly from LexisNexis in compliance with the Fair Credit Reporng Act containing informa-

on regarding all the criminal records associated with the name, which may not necessarily be the

league volunteer.

Only aach to this applicaon copies of background checkreports that reveal convicons of this applicaon.

Lile League Volunteer Applicaon -2012Do not use forms from past years. Use extra paper to complete if addional space is required.

Plas ls hr rrncs, a las on o whch has knowl o yor parcpaon as

a volunteer in a youth program:

Name/Phone

______________________________________________________________________

______________________________________________________________________

AS A CONditi ON O f vOLuN teeRiNg , i prmsson or h Ll La

oranzaon o conc backron chck(s) on m now an as lon as i conn o

b ac wh h oranzaon, whch may ncl a rw o sx onr rsrs,

chl abs an crmnal hsory rcors. i nrsan ha, appon, my poson s

cononal pon h la rcn no nappropra normaon on my backron.

i hrby rlas an ar o hol harmlss rom lably h local Ll La, Ll

La Basball, incorpora, h ocrs, mploys an olnrs hro, or any

ohr prson or oranzaon ha may pro sch normaon. i also nrsan ha,

rarlss o pros apponmns, Ll La s no obla o appon m o a

olnr poson. i appon, i nrsan ha, pror o h xpraon o my rm,

i am sbjc o sspnson by h Prsn an rmoal by h Boar o drcors orolaon o Ll La polcs or prncpls.

Applicant Signature _______________________________________da _________

i Mnor/Parn Snar___________________________________da __________

Applcan Nam(plas prn or yp) _______________________________________

NOTE: The local Lile League and Lile League Baseball, Incorporated will not discriminate

against any person on the basis of race, creed, color, naonal origin, marital status, gender, sexual

orientaon or disability.

A COPY OF VALID GOVERNMENT ISSUED PHOTO IDENTIFICATION MUST BEATTACHED TO COMPLETE THIS APPLICATION.

Nam __________________________________ da ___________________

Address ________________________________________________________Cy ____________________________ State _________Zip _____________

Cll Phon Bsnss Phon

e-mal Arss:

da o Brh ____________________________________________________

Occpaon _____________________________________________________

Social Security # (manaory pon rqs or wh LxsNxs)____________________

employr _______________________________________________________

Address ________________________________________________________

Special professional training, skills, hobbies: ___________________________

_______________________________________________________________

Commny alaons (Clbs, Src Oranzaons, c.):

_______________________________________________________________

Pros olnr xprnc (ncln basball/soball an yar):

_______________________________________________________________

do yo ha chlrn n h proram? Ys No i ys, ls ll nam an

wha ll? _____________________________________________________

Spcal Crcaon (CPR, Mcal, c.): ______________________________

do yo ha a al rr s lcns: Ys No

drrs Lcns#: ________________________________State ___________

Ha yo r bn conc o or pla ly o any crm(s): Ys No

i ys, scrb ach n ll: _________________________________________

_______________________________________________________________

Are there any criminal charges pending against you regarding any crime(s) involvingor aans a mnor? Ys No i ys, scrb ach n ll:________________________________________________________________________________

Ha yo r bn rs parcpaon n any ohr yoh prorams? Ys No

i ys, xplan: ___________________________________________________

_______________________________________________________________

in whch o h ollown wol yo lk o parcpa? (Chck on or mor.)

La Ocal Coach umpr fl Mannanc

Manar Scorkpr Concsson San Ohr

10211vOLuNteeR APPLiCAtiON 3/28/11

ECLL Registration Packet 2012

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