Lawrence County Youth Baseball and Softball, Mac Dale Park - (Monticello, MS)

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2025 Lawrence County 5-6 year old co-ed Registration

PLAYER INFORMATION

* PLAYER First Name:

* PLAYER Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

Gender:

* Player Shirt Size:

Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT FOR PARTICIPANTS & MEDICAL RELEASE

IN CONSIDERATION OF my son/daughter allowed to participate in any way with the Lawrence County Dixie Boys, Pre-Majors, and Majors Baseball and Lawrence County Dizzy Dean Baseball, owned the Mac Dale Memorial Park Foundation (hereinafter "Mac Dale Foundation"), for the purposes of playing baseball including, but not limited to, practices, games, transportation to and from practices, games, and/or related events and activities, the undersigned acknowledges, appreciates, and agrees that:

1. The risk of injury for my son/daughter from the activities involved in baseball activities is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2. The risk of possible exposure to an illness from infectious diseases is significant, including but not limited to MRSA, influenza, and COVID-19. While particular rules for personal discipline reduce this risk, the risk of serious illness and death does exist; and,

3. For myself, spouse, and child/ward, I knowingly and freely assume all such risks, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

4. I willingly agree to comply with the LCDBB and the Mac Dale Foundation's stated and customary terms and conditions for participation including risk of injury and protection against infectious diseases. If I observe any unusual or significant hazard or concern in my readiness for participation, I will remove my son/daughter from participation; and,

5. MEDICAL RELEASE. I grant permission to managing and/or coaching personnel and/or Mac Dale Park representatives or officials to authorize and obtain medical care and treatment from any licensed physician, hospital, or medical clinic, including major surgery, deemed necessary by a duly licensed physician should I become ill or injured while participating in baseball activities or at any other time when I am unable to grant authorization for emergency treatment. This authorization includes the administration of first aid and transportation to and from a medical treatment facility. In addition, I will list any allergies or illnesses for which my son/daughter are being treated by medical professionals in the space provided next to my signature.

6. I, for myself, my spouse, my child(ren), and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the Mac Dale Foundation, their affiliates, members, and directors of the same, the team manager, my son/daughter's teammates, team managers, and team members of participating teams, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of the premises used to conduct the tournament (?Releasees?), WITH RESPECT TO ANY ILLNESS, INJURY, DISABILITY, DEATH, or loss or NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

7. I, for myself, my spouse, my child(dren), and on behalf of my/our heirs, assigns, personal representatives, and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in the tournament, EVEN IF ARISING FROM THEIR NEGLIGENCE to the fullest extent permitted by law.

8. I assert that I have read and fully understand the hereinabove and fully understand the risks of the activity, my responsibilities for adhering to the rules and regulations, and that I, again, restate that I FULLY UNDERSTAND THIS AGREEMENT.

I/we agree with the above waiver. *

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