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2020 Challenger League Sign-Up
Today's Date
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Primary Contact Information
Street Address
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Address Line 2
City
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State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
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Phone Number
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Primary Contact Name
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Primary Contact Mobile Phone
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Primary Contact Email
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Best form of Contact is:
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Text
Email
Telephone
Preferred Language of Communication
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I Can Help As
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Manager
Coach
Buddy
Sponsor
Not at this time
Secondary Contact Information
Please include Secondary Contact in all Communication
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Yes
No
Secondary Contact Name
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Secondary Contact Mobile Number
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Secondary Contact Email
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Best form of Contact is:
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Text
Email
Telephone
Preferred Language of Communication
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I Can Help As
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Manager
Coach
Sponsor
Buddy
Not at this time
Player One Information
Player's First Name
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Last Name
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Date of Birth
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1st Child Gender
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Prefer not to answer
Male
Female
My child is:
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Right Handed
Left Handed
Player's age at start of season
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4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Played in league last year?
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Yes
No
If yes, which division and team did they play?
What type of incentives and/or positive reinforcements work for your child?
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Early Registration (Rates will increase to $200.00 as of October 8th, 2019)
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1st Player Registration - $200.00
Bronxchester Challenger League
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Tee Ball (4-6 year olds) - $200.00
Minors (7-9 year olds) - $200.00
Majors (10-21 year olds) - $200.00
FOR MAJORS (10-21) ONLY: There will only be 30 players for each Majors (10-21) session. Please choose a session time you prefer. PLEASE NOTE Your choice is not guaranteed.
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Majors 1 pm
Majors 2:30 pm
Not Applicable
1st Child Pants Size
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YS
YM
YL
YXL
AS
AM
AL
AXL
AXXL
1st child Jersey Size
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YS
YM
YL
YXL
AS
AM
AL
AXL
AXXL
Player Two Information
2nd Child First Name
2nd Child Last Name
2nd Child Date of Birth
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2nd Child Gender
Prefer Not to Answer
Male
Female
My child is:
Right Handed
Left Handed
2nd Player's age at start of season
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Played in league last year?
Yes
No
If yes, which division and team did they play?
What type of incentives and/or positive reinforcements work for your child?
Early Registration (Rates will increase to $175.00 as of October 8th, 2019)
2nd Child Registration $175.00
2nd Child Bronxchester Challenger League
Tee Ball (4-6 year olds) - $175.00
Minors (7-9 year olds) - $175.00
Majors (10-21 year olds) - $175.00
FOR MAJORS (10-21) ONLY: There will only be 30 players for each Majors (10-21) session. Please choose a session time you prefer. PLEASE NOTE Your choice is not guaranteed.
*
Majors 1 pm
Majors 2:30 pm
Not Applicable
2nd child Jersey Size
YS
YM
YL
YXL
AS
AM
AL
AXL
AXXL
2nd Child Pants Size
YS
YM
YL
YXL
AS
AM
AL
AXL
AXXL
Player Three Information
3rd Child First Name
3rd Child Last Name
3rd child Date of Birth
+
3rd Child Gender
Prefer Not to Answer
Male
Female
My child is:
Right Handed
Left Handed
3rd Player's age at start of season
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Played in league last year?
Yes
No
If yes, which division and team did they play?
What type of incentives and/or positive reinforcements work for your child?
Early Registration (Rates will increase to $125.00 as of October 8th, 2019)
3rd Child Registration $125.00
3rd Child Bronxchester Challenger League
Tee Ball (4-6 year olds) - $125.00
Minors (7-9 year olds) - $125.00
Majors (10-21 year olds) - $125.00
3rd child Jersey Size
YS
YM
YL
YXL
AS
AM
AL
AXL
AXXL
3rd Child Pants Size
YS
YM
YL
YXL
AS
AM
AL
AXL
AXXL
FOR MAJORS (10-21) ONLY: There will only be 30 players for each Majors (10-21) session. Please choose a session time you prefer. PLEASE NOTE Your choice is not guaranteed.
*
Majors 1 pm
Majors 2:30 pm
Not Applicable
Medical Information
Player One- Disability Diagnosis:
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Communication:
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Verbal
Non-Verbal
Please list any allergies/medical problems, including those requiring maintenance medications (i.e. Diabetic, Asthma, and Seizure Disorder):
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Upload profile image of child(ren)
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Upload IEP and/or other document listing Diagnosis
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Player Two - Disability Diagnosis:
Communication:
Verbal
Non-Verbal
Please list any allergies/medical problems, including those requiring maintenance medications (i.e. Diabetic, Asthma, and Seizure Disorder):
Upload profile image of child(ren)
Upload IEP and/or other document listing Diagnosis
Player Three - Disability Diagnosis:
Please list any allergies/medical problems, including those requiring maintenance medications (i.e. Diabetic, Asthma, and Seizure Disorder):
Communication:
Verbal
Non-Verbal
Upload profile image of child(ren)
Upload IEP and/or other document listing Diagnosis
Emergency/Medical Authorization
Emergency Contant Name:
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Emergency Contant Relationship:
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Emergency Contant Number:
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Medical Coverage:
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In case of emergency if family and/or family physician cannot be reached, what would you like us to do?
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Upload Copy of your's Health Insurance Card
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Release Form
In consideration of D3 Sports & Recreation Inc. providing the opportunity for my child(ren) to participate in the Bronxchester Challenger League, the undersigned does hereby release and agree to indemnify and hold harmless D3 Sports & Recreation Inc. and its officers and directors from any and all claims for personal injury, death, property damage, or any type of claim or damage (including but not limited to attorney's fees or litigation expenses) resulting from my child's activities in connection with participation in Bronxchester Challenger League or the participation of any family member or guest of the undersigned. I assume all risks and hazards incidental to such participation in Bronxchester Challenger League games and activities and consent for my child to receive first aid and/or emergency care by a qualified Emergency Medical Technician or physician or other person qualifies to render medical assistance in the event my child suffers an injury during sanctioned games and activities. I/we agree to be present at all games and activities so that I/we can manage our child's specific needs. I agree to have any and all medication (prescription and non-prescription) for my child and shall be solely responsible for dispensing any such medication to my prescription) for my child and shall be solely responsible for dispensing any such medication to my child(ren).
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Parental Consent, Photo and Video Release Form
I give permission to D3 Sports & Recreation Inc. to post photos and/or video of my child/children to the D3 Sports & Recreation Inc. website and the page (s) of social communication. I further state that I have the right to give this permission as I am the parent/legal guardian of the child/children.
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clear
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