2023 Bombers Registration
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Player Name *
Age Group *
Address *
Phone Number *
Date of Birth *
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/
DD
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YYYY
Parent Guardian #1 *
Address *
Parent/Guardian Phone Number *
Parent Guardian Email *
Parent Guardian #2
Address
Phone Number
Email
Emergency Contact *
Emergency Contact Phone Number *
Relationship to Player *
Insurance Carrier *
Policy Number *
Registration Fees
Registration Fee is $100 (Must be received by Dec 15th)
Venmo- @bombers-ladybombers
Checks Payable: Brushtown Bombers
Mail Checks: 15 Franklin Drive McSherrystown PA 17344


WAIVER INFORMATION
By submitting this form you give your consent for your child's participation in any and all Brushtown Bombers Baseball/Brushtown Lady Bombers Softball functions or activities. In the event of any injury or sickness occurring during any Brushtown Bomber Baseball/Lady Bombers Softball functions or activities, you authorize any official(s) to administer first aid and if necessary to transport your child to the nearest emergency treatment.

You release Brushtown Bombers Organization and any person(s) connected with Brusthown Bomber Baseball/Lady Bombers Softball of any responsibility from accident or injury incurred as a result of his participation in any and all activities, including transportation to and from any Brushtown Bombers Baseball/Lady Bombers Softball functions or activities.

You certify that you child has been given a physical examination and is physically able to participate in all related activities. Please notify in writing any prescribed medications and / or physical conditions of which the Brushtown Bombers Baseball coaching staff should be aware of are listed below.
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