Fairfield Pirates Baseball Club

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2023 Fairfield Pirate Baseball Club Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Email:

* TEAM:

PARENT/GUARDIAN

* Firstname:

* Lastname:

* EMail:

* Cell Phone:

* Additional Contact- Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

I hereby authorize the Fairfield Pirates Coaches and emergency care personnel to provide and render necessary medical care and treatment of myself and/or the registered child for any illness or injury, which may be suffered at any time while participating in Fairfield Pirate baseball programs. It is understood that time permitting, specific permission from parent/guardian or family member will be secured in the event that any medical treatment is to be undertaken, but that should any emergency arise, this authorization and consent will cover such an event. Also, I/we hereby accept responsibility for any accident which may occur in connection with this baseball activity, hold harmless the Fairfield Pirates Baseball Club and it's officers and all other parties involved in the promotion and/or conducting of the above named activity. As well, I understand that the Fairfield Pirates baseball club, I further agree to indemnify and hold harmless the Fairfield Pirates Baseball club in the promotion and/or conducting of said program(s) identified above, from any claim I might make or any and all third party claims or damages arising in connection with participation with or in the stated programs. I also certify that I or my child has had a physical examination signed by a physician within the last year and that my child is in good health and able to participate in baseball and/ or programs. Special physical and/or medical limitations requiring medication or special treatment have been listed earlier in this registration process.

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2023 Fairfield Pirate Baseball Club Registration Form