2004

PENNSYLVANIA STATE CONNIE MACK BASEBALL

PLAYER RELEASE FORM

BUX-MONT LEAGUE

This form is to be used by all Bux-Mont League Organizations and applies to the

‘A’, ‘B1’, ‘B’ 'C1' and ‘C’ Leagues

Please Print all information below except for signatures.

Player Information:

Name: ____________________________

Address: ________________________________________

Township: _________________________________________

Telephone: _________________________________________

Reason for Release: ______________________________________________________

______________________________________________________

______________________________________________________

Name of Organization giving the release: ______________________________________

Name of Releasing Organization Official: _____________________________________

Signature: ____________________________ Date: __________

Released to Organization: ______________________________________________

Signature of Bux-Mont League Official: _______________________ Date: __________

NOTE TO PARENTS (GUARDIANS): Please understand that if this Release is approved by League Officials, it will be the last one. League rules do not allow for more than one release per player – NO MATTER WHAT THE REASON.

Parent (Guardian) Signature _________________________ Date:__________________