We need some information about you, the Parent/Guardian. Even if you are registering a child, we need your information first. You have the option to add a second Parent/Guardian. You will enter your child’s information on the next screen.
Authorized Parent/Guardian Signature
Date of Birth:
League Name: Beach Cities Miracle League
Parent or Guardian Authorization:
In case of emergency, if family physician cannot be reached, I hereby authorize my child/ myself to be treated by Certified Emergency Personnel. (i.e. EMT, First Responder, E.R. Physician)
In case of emergency contact:
Please list any allergies/medical problems, including those requiring maintenance medication. (i.e. Diabetic, Asthma, Seizure Disorder)
The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.
Date of last Tetanus Toxoid Booster:
WARNING: Protective equipment cannot prevent all injuries a player might receive while
participating in Baseball/Softbal/Basketball.
Miracle League does not limit participation in its activities on the basis of disability,
race, color, creed, national origin, gender, sexual preference or religious preference.