BUDDY NAME:

GENDER:                       MALE   FEMALE

DATE OF BIRTH:

HOME PHONE NUMBER:

CELL PHONE NUMBER

EMAIL ADDRESS:

STREET ADDRESS:

CITY:          
COUNTY:     
PROVINCE:  
POSTAL CODE:

SCHOOL (if applicable):

SOCIAL INSURANCE NUMBER (if 18 or older):

DRIVERS LICENSE NUMBER (Background checks will be performed on all volunteers over 18):

VOLUNTEER'S SHIRT SIZE:
Youth size:    S    M    L    XL
Adult size:     S    M    L    XL    XXL

PARENT/GUARDIAN FULL NAME (if under 16):

WORK OR CONTACT NUMBER:

EMAIL ADDRESS:

FOR ADDITIONAL INFORMATION PLEASE CONTACT THE AMHERSTBURG MIRACLE LEAGUE REGISTRATION DIRECTOR, JACKIE HAY AT jackiehay@amherstburgmiracle.com,

OR TELEPHONE CHUCK BONDY AT: 519-919-4641

*PLEASE NOTE: YOU WILL HAVE TO SIGN A WAIVER WHEN VISITING THE MIRACLE LEAGUE FIELD FOR THE FIRST TIME.