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Registration Form - Fall Ball 2024

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

* Email:

* Gender:

* Grade Entering in Fall:

* Age Group Trying out For:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* Relationship to player:

* EMail:

* Home Phone:

* Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Relationship to player:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

* Insurance Carrier:

* Policy #:

WAIVER INFORMATION

Parent or Guardian Authorization, Disclaimer, and Waiver of Liability

I parent of Guardian of my registered child does hereby give approval of his/her participation in any and activities during the current season. I assume all risks and hazards incidental to such participation, including transportation to and from activities and do hereby waive, release, indemnify, and agree to hold harmless Mud Dog Baseball, the organizers, sponsors, officers, participants, property owners, and persons transporting the boy and girl to and from activities, for and any claims arising out of an injury to any boy or girl.

I also grant permission to manage personnel or other league representatives to authorize and obtain medical care from any licensed physician, hospital, or medical clinic, if boy or girl should become ill or injured participating in league activities anytime while parent or guardian are not present.

I/we agree with the above *

* indicates required fields