Miracle League of the Lehigh Valley

Player Registration

Registration Fee: $40 per family per year
Season starts May 2010
Scholarships are available
Registration starts January 1, 2010

Player Name:

Gender:

Male Female

Date of Birth:

Home Phone:

Street Address:

City: County:

State: Zip: School:

Diagnosis:

Special needs:

Player's shirt size:

Youth size:

S M L

Adult size:

S M L XXL

Favorite color:

Favorite food:

Favorite TV show / Movie:

Favorite song:

Parent Information
Parent/Guardian Full Name:
Work or Contact Number:
Email:
I will also volunteer for (check all that apply)
Activity Committee	Concession Stand
Team Parent	Game Announcer
Coaching	Scoreboard Operator / Sound Operator

Please make checks or money orders payable to Miracle
League of the Lehigh Valley. Mail payment and form to:

Miracle League of the Lehigh Valley
P.O. Box 180
Whitehall, PA 18052

Note: You will have to sign a waiver on your first time visiting the Miracle League Field.