Player application Chippewa Valley Miracle League 2021 season player registrationThe Chippewa Valley Miracle League is an organized baseball league for children ages 4-19 with cognitive and/or physical disabilities. Players will be notified of their teams in April. League play will begin the week of June 7 and end the week of August 2, with an optional All-Star game the week of August 2. Regular-season games begin Monday, June 7. Games are played Monday and Wednesday at 5:45 and 7 p.m. Each player will play one game a week. Registration deadline is March 31. In the best interest of the player, a parent/guardian must attend the player's baseball game. This is not a drop-off league.Player's name* First Last NicknameGender* Male Female Date of birth* Age as of June 1, 2021*School*Parent(s)/guardian(s) name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Home phone*CellphoneEmail* Emergency contact and phone number*Race*Number of members in household/number of males/number of females*This is my first year playing Miracle League baseball:* Yes No If no, team name from last year and where:Player shirt size* Youth small Youth medium Youth large Youth XL Adult small Adult medium Adult large Adult XL Adult XXL Adult XXXL If the wrong shirt size is ordered, a $20 fee will be charged for a replacement.What days of the week are you available to play?* Monday/Wednesday Tuesday/Thursday Either is fine To help us better connect with your childDoes your child have any nicknames?What are some of your child's favorites (songs, foods, etc.):*What are some of your child's specific interests or hobbies (TV shows, movies, games, etc.):*Does your child have any unique talents:*Handedness* Right-handed Left-handed What are you expecting to gain from the league?Please tell us about your child's diagnosis to help us pair your child with a buddy:* Intellectual/cognitive disability Down syndrome Orthopedic disability Spina bifida Hearing impairment Visual impairment Muscular dystrophy Asperger's syndrome Cerebral palsy Cardiac impairment ADHD Epilepsy/seizure disorder Autism General motor impairment Other (please specificy):Does your child require any assistive devices such as electric or manual wheelchair, braces, hearing aids, glasses, contacts or other mobility equipment?* Yes No If yes, please list:General characteristics of behavior/activity levelMy child is:* Verbal Nonverbal Other communicative devices used If uses other communicative devices, please explain:Is your child a wanderer/runner?* Yes No Does your child have aggressive behaviors?* Yes No If yes, explain behaviors:Is your child toilet-trained?* Yes No Will your child indicate a need to use the restroom?* Yes No Can your child use the restroom independently?* Yes No What behavior-management tools work well with your child?List any activities or actions that frighten your child or cause him or her to shut down:Is there any other pertinent information that may help our team work more efficiently and effectively with your child during league?Volunteer buddy informationMy child prefers a volunteer who is:* Male Female Either I would like the Miracle League to provide a buddy to be on the field with my child. What type of buddy would be best for your child?* Adult Young adult Teen I will be providing my child's own buddy. Name of volunteer buddy is:Just a reminder that volunteers need to fill out the volunteer registration form.I would like my buddy from last year. Name of buddy:Just a reminder that volunteers need to fill out the volunteer registration form.How did you hear about the Chippewa Valley Miracle League?I give authorization for my above-named to participate in the Chippewa Valley Miracle League. I know that participation in baseball may result in serious injuries and protective equipment does not prevent all injuries to players, and I do hereby waive, release, absolve, indemnify and agree to hold harmless the Chippewa Valley Miracle League, Goodwill NCW and the City of Eau Claire, their organizers, sponsors, agents, insurers, supervisors, participants and volunteers from any claim arising out of any injury to my/our child whether the result of negligence or for any other cause. I hereby grant the Chippewa Valley Miracle League, its affiliates, franchises, advertising and promotional agencies and their agents, the irrevocable, unrestricted right to use, publish, display and distribute materials bearing my name, voice, likeness or any other identifiable representation of myself, my family members including my Miracle League player/child. These materials may appear in any form, style, color or medium whatsoever (including without limitation, photographs, videotapes, films, sound recordings, software, drawings, prints, broadcast, internet and electronic media). I agree that all material containing identifiable representation of me (including without limitation all negatives, plates and masters of any photographs, files, prints or tapes) shall be and remain the sole and exclusive property of the Chippewa Valley Miracle League. I hereby release and forever discharge the Chippewa Valley Miracle League from any and all liability and damages relating to the use of my name, voice, likeness or any other identifiable representation of me. I hereby waive any right I may have to inspect or approve the finished materials or any part or element thereof that incorporate my name, voice, likeness or any other identifiable representation of myself, my family including my Miracle League player/child.Please check yes:* Yes UntitledFirst ChoiceSecond ChoiceThird ChoiceRegistration Fee:$45/player ($5 discount for multiple family members) $60/player if received after registration deadline (March 31st)Payment Type:*Self PayAlternative funding sourcePlease list case worker name and phone numberPhoneThis field is for validation purposes and should be left unchanged.