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Pitching Lesson request

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone / Cell Phone:

* Birthdate:

Email:

* Gender:

* Grade:

Please Give at least 24 hours notice

Location- Mystic Indoor Sports
Address: 90 Welles Rd, Mystic, CT 06355

* Session Date:

* Session Length:

PARENT/GUARDIAN Contact Information

* Firstname:

* Lastname:

* EMail:

* Home Phone:

* Work Phone:

* Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

Phone:

* Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

*** By clicking Submit, I agree to not hold the CT Clippers or any member of the CT Clippers Coaching staff or CT Clippers administration liable for any injuries sustained during training.
I am aware this is an at your own risk event. ***

I/we agree with the above and have read the waiver information. *

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