LITTLE LEAGUE® BASEBALL AND SOFTBALL
Report of Players Claimed under
Regulation II(d) or II(a)
Date: _________________
League Name: ________________________________ League ID#: ___________________________________
League President: ___________________________________________________________________________
Current Baseball Level Tee Ball Major/Little League Junior League
Division Soball (Check One) Minor League Intermediate (50/70) Senior League
(Check One)
Player’s Name: _____________________________________________________________________________
Player’s Date of Birth ________________________________________________________________________
1. Former Address Within Boundaries: __________________________________________________________
2. Former School Location Within Boundary: _____________________________________________________
3. Divisions Played and Year: __________________________________________________________________
is claim under II(d) is being led because
e player’s address or school location changed
e league’s boundaries have changed
e player is a sibling of a player who previously qualied for II(d) or II(a)
Please indicate name of sibling that qualies this player under Regulation II(d) or II(a) __________________________
Verication: League President: ________________________________________________________________
District Administrator: ___________________________________________________________
If the Charter/Tournament Committee subsequently nds that the information submitted as acceptable documentation regarding
Regulation II(d) or II(a) now shows that the previously submitted information/documentation was falsied, misrepresented or
insucient then Little League Baseball, Incorporated reserves the right to impose sanctions and/or penalties on all appropriate parties,
including but not limited to players, coaches, league ocials, and/or the league which could result in suspension and/or terminations
with Little League Baseball, Incorporated.
e District and the Local League will maintain this form and supporting documentation in their les. Completion of this form is
only required ONCE during a participant’s career.
Last Updated: 03/08/18 - Previous editions of this document are obsolete.
Signature Name
Signature Name
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Street City State Zip
Street City State Zip
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(Please Print)
Challenger
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