WEST VIRGINIA MINERS TRAVEL BASEBALL TEAM REGISTRATION FORM
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PLAYER INFORMATION
Player's Full Name (First Name & Last Name) *
Date of Birth *
MM
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DD
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YYYY
Address *
City *
State *
Zip Code *
Health Issues/Restrictions/Allergies, etc. *
Jersey Number (First Choice) *
Jersey Number (Second Choice) *
T-Shirt Size *
Pants/Shorts Size *
PARENT / GUARDIAN INFORMATION
Guardian #1 Full Name (First Name & Last Name) *
Address *
City *
State *
Zip Code *
Mobile Phone *
Email Address *
Occupation *
Guardian #2 Full Name (First Name & Last Name)
Address
City
State
Zip Code
Mobile Phone
Email Address
Occupation
MEDICAL RELEASE INFORMATION
A Medical Release Form, signed by the player's parent or legal guardian, MUST be provided in advance of any participation for each player on the tournament team in order that physicians and hospitals will accept players for treatment in the event of illness or injury, where the parent(s) or legal guardian(s) are not immediately available.
Policy Holder's Full Name (First Name & Last Name) *
Health Insurance Company *
Policy or Certificate Number *
This is to certify that as the parent or guardian of this player on the West Virginia Miners (8U, 9U, 11U, 12U, 13U, 14U) Travel Baseball Team, hereby grant permission to the adult manager, coach, trainer, team coordinator or business manager of the team to obtain medical care, at my expense, from any licensed physician, hospital, or medical clinic for the player named herein as such times as either parent or legal guardian cannot be contacted in person or by telephone. This authorization shall include all activities, including the period required to travel to and from those activities: and we hereby waive, release, absolve, indemnify, and agree to hold harmless the organizers, supervisors, participants, and persons transporting the player to and from those activities, for any and all claims arising out of an injury to the player.

If this information should change anytime throughout the 2024-2025 season, I will make the West Virginia Miners organization aware of the change to update our information.
*
Required
Date of Permission Granted *
MM
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DD
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YYYY
WAIVER, CONSENT AND RELEASE OF LIABILITY
CLICK HERE to read the WAIVER, CONSENT AND RELEASE OF LIABILITY document. 
I have read the above disclosure state, waiver, consent and release of liability, disclaimer, assumption of risk and waiver, and acknowledge and consent agreements, fully understand the terms of each, understand that I have given up substantial right by my signing this form and agreeing to these terms, and I sign this form and agree to these terms freely and voluntarily and without inducement of any kind. *
Required

WEST VIRGINIA MINERS TRAVEL BASEBALL ORGANIZATION RULES & REGULATIONS

CLICK HERE to read the West Virginia Miners Travel Baseball Organization Rules & Regulations.
I/We have read and agree to abide by all the rules and regulations set forth by the West Virginia Miners Travel Baseball Organization. *
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