Gastineau Channel Little League

Player Registration Form – Page 1

Last Name_________________________ First Name___________ MI ______

Street Address____________________________________________________

City_____________________________ State___________ Zip Code________

Night Phone________________ Sex_________ Birth date_________________

Grade_________ School___________________ Birth Certificate # __________

Father’s Last Name______________ First Name___________ Phone________

Father’s Occupation_________________________ Email__________________

Father will help with Team_____ League_____ Umpire_____ How? _________

Mother’s Last Name______________ First Name___________ Phone________

Mother will help with Team_____ League_____ Umpire_____ How?__________

Mother’s Occupation_________________________ Email__________________

Emergency________________________ Phone________ Relationship_______

Doctor__________________ Phone______________ Allergies_____________

Please return your registration as soon as possible because players will be wait listed if teams are full.

Complete the above information and return completed registration material to:

GCLL, P.O. Box 33694, Juneau, Alaska 99803

The following must be included:

1. Completed registration form (this page).
2. Signed and completed Medical Release with insurance information (page 2).
3. Copy of birth certificate.
4. Registration payment (checks made payable to GCLL or credit card information).
5. Daytime phone number if we need to get a hold of you.

Watch the newspaper and website for tryout dates and time.

*****Supported in part by City and Borough of Juneau Sales Tax Revenues*****