Event registration

Details

Rep Policy Acknowledgement Form

Sun 01 Jan 2023 00:00 — Wed 31 Dec 2025 00:15

Stevenson Park Softball Diamonds, Stevenson Park, Stevenson Ave Mayfield 2304

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Are you attending this event?

Yes No Maybe

Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Please list any relevant medical information Eg: Asthma, epilepsy, allergies, diabetes, and any other relevant information about current medical condition* Max 255 characters

Please list any current medication that needs to be administered at the state championships* Max 255 characters

Please list any injuries that have occurred in the last 24 months* Max 255 characters

Please list any current injuries* Max 255 characters

Glasses/contact lenses worn?*

Emergency Contact Name*

Emergency Contact Number*

Emergency Contact Relationship to Player*

Do you wish to purchase a MALE playing shirt ($40)?

Do you wish to purchase a FEMALE playing shirt ($40)?

What Number do you want on your shirt? (list 3 in order of preference)

Do you want your surname on your playing shirt?

Do you wish to Purchase Socks ($15)? List size and quantity (XS, S, M, L, XL)

Do you wish to purchase a hat ($30)?

Do you wish to purchase a hoodie ($70)?

Do you wish to purchase a jacket ($95)?

I have read and understood the NDSA Representative Program Policy and agree to adhere to this policy in full.*

Yes

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*

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