Online Form

 

Standard paper registration applications are also available on the download page.

 

 

Player's Information Section

 
Player's last name first name nick name
     
 
  Birth Date Age (on january 1, 2010)
     
 
  School Gender
     
Was child a Delta Little League player last year? if so, what Team? Shirt Size anticipated for 2010 season
     
Parent's Contact: BEST Email address BEST contact Phone # 2nd Choice Phone
     
 
Player Street address  
Player city Player State Player Zip
     
Medical Release Section
IN THE EVENT OF AN EMERGENCY, IF THE FAMILY PHYSICIAN CAN NOT BE REACHED, I HEREBY GIVE AUTHORIZATION TO OBTAIN MEDICAL TREATMENT FOR THE ABOVE NAMED MINOR. THIS AUTHORIZATION COVERS ANY EMERGENCY TREATMENT DEEMED NECESSARY BY THE ATTENDING PHYSICIAN, NURSE PRACTIONER, NURSE OR EMERGENCY MEDICAL TECHNICIAN. I UNDERSTAND THAT I, THE UNDERSIGNED, AM RESPONSIBLE FOR ALL MEDICAL COSTS AND THAT DELTA LITTLE LEAGUE’S AND LITTLE LEAGUE BASEBALL’S INSURANCE IS THAT OF CO-INSURANCE AND SHALL NOT BE CONSIDERED PRIMARY INSURANCE. THERE IS A PER INCIDENT DEDUCTIBLE AND COVERAGE LIMITATIONS.
Parent or Guardian Authorization for medical treatment.
 
Family Physician Name Physician's Phone  
     
Insurance Provider ID/Group # Date of last Tetanus Texoid Booster
     
Please list medical diagnosis, Medications, with Dosage and frequency
Please double check your entries
Medical Diagnosis #1 Medicine #1 Dosage and Frequency #1
     
Medical Diagnosis #2 Medicine #2 Dosage and Frequency #2
     
Medical Diagnosis #3 Medicine #3 Dosage and Frequency #3
     
Parent/Guardian Information
Player resides with:
     
Father's Information:
 
Father's Last Name Father's First Name  
     
Father's work phone Father's Home phone Father's Occupation
     
Street Address
(if differerent than player) 		City and State
(if differerent than player)		 Zip
(if differerent than player)
     
Mother's Information:
 
Mother's Last Name Mother's First Name  
     
Mother's work phone Mother's Home phone Mother's Occupation
     
Street Address
(if differerent than player) 		City and State
(if differerent than player)		 Zip
(if differerent than player)
     
Guardian's Information:
 
Guardian's Last Name Guardian's First Name  
     
Guardian's work phone Guardian's Home phone Guardian's Occupation
     
Street Address
(if differerent than player) 		City and State
(if differerent than player)		 Zip
(if differerent than player)
     


 

Incomplete registration forms can NOT be accepted.