Player's Name *

First Name

Last Name

Birth Date

MM

DD

YYYY

Parent / Guardian

First Name

Last Name

Primary Phone # *

(###)

###

####

Secondary Phone #

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Player's ability to throw a baseball: *

Can throw the ball without assistance

Will need assistance in direction to throw the ball

Will need assistance throwing the ball

Player's ability to run the bases *

Can run bases without assistance

Will need direction when running bases

Will need assistance running bases

Player's ability to hit the ball *

Would like the ball to be pitched

Can hit the ball off the tee without assistance

Will need assistance hitting the ball from the tee

Player's ability to catch the ball *

Can catch the ball most of the time without assistance

Needs to be taught how to catch the ball

Will need assistance catching the ball

Player's mobility *

Ambulatory

Crutches / Walker

Manual Wheelchair

Electric Wheelchair

What team was your player on previously?

Woodard

Century Next (Bank of Ruston)

First National

Origin Bank

Don't recall / hasn't played before

I decline my child's photo to be used in Buddy Ball of Ruston publications.

Tshirt Size *

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL