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TOWN OF BROOKHAVEN BASEBALL
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2025/26 TOB BASEBALL INDIVIDUAL PLAYER AGREEMENT/WAIVER FORM
PLAYER INFORMATION
Youth Player Waiver Information Form (A player is not legally registered until this form is filed online).
*
Team Name:
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Age Group(s):
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First Name:
*
Last Name:
*
Street:
*
City:
*
State:
*
Zip Code:
*
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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2001
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2015
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2019
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I,:
hereby wish to register in the Brookhaven Town Youth Baseball Program. By signing this form, I subject myself to the rules and regulations governing play in the Town of Brookhaven Youth Baseball Program. Violations of these rules and regulations may result in disciplinary action against me.
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ELECTRONIC PLAYER SIGNATURE:
Parent/Guardian Permission
*
First Name:
*
Last Name:
*
Street:
*
City:
*
State:
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Zip:
*
EMail:
WAIVER AND LIABILITY RELEASE
*
I,:
*
ELECTRONIC PARENT SIGNATURE:
* indicates required fields