Pacific Coast Rangers

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Player Registration

PLAYER INFORMATION

* Last Name:

* First Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

Email:

* High School:

* Grad Year:

G.P.A.:

SAT Score:

ACT Score:

* Referred by:

Primary Position:

Secondary Position:

Bats:

Throws:

PARENT/GUARDIAN

* Firstname:

* Lastname:

* EMail:

* Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

* Insurance Carrier:

* Policy #:

WAIVER INFORMATION

1. I/we agree to allow our son to participate in the Pacific Coast Rangers Scout Team Workouts and/or Games.

2. I we/understand, acknowledge and appreciate the risks and dangers involved in allowing our son to participate. I/we assume all risks of injury and damage incident to his participation. I/we further in consideration of the privilege to tryout and/or play games, I/we hereby release, discharge and relinquish the Pacific Coast Rangers, its Officers, Agents, their Representatives, Employees and Officials of and from all claims, demands, actions and cause of action of any sort, for any injuries sustained by our son.

3. Finally, I/we agree in the event of illness or injury to our son during the Pacific Coast Rangers Scout Team Workouts and/or Games, I/we hereby give consent for the performance of such diagnostic, medical and/or surgical treatment on my son as may be deemed medically necessary in order to assure the safety of my son.

By clicking the submit button below, I/we agree to the above-referenced terms.

I/we agree with the above *

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