Ventura County Jim Colborn Baseball League VCJCBL

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2017 VCJCBL PLAYER REGISTRATION FORM

* VCJCBL TEAM ASSIGNED TO:

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

State:

* Zip Code:

* Contact Phone:

* Birthdate:

* Email:

Gender:

PARENT/GUARDIAN #1 (under 18)

* Firstname:

* Lastname:

EMail:

* Home Phone:

* Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2(under 18)

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

* Insurance Carrier:

* Policy #:

WAIVER INFORMATION

RELEASE OF LIABILITY FOR PARTICIPANTS
READ BEFORE ELECTRONICALLY SIGNING

IN CONSIDERATION OF THE PLAYER NAMED ON THIS FORM, being allowed to participate in any way as a member of VCJCBL in Ventura County, CA., and all related events and activities including, but not limited to, the practice, training, and games. The undersigned acknowledges, appreciates, and agrees that:

1. The risk of injury to THE NAMED PLAYER from the activities involved in these programs 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. FOR MYSELF, SPOUSE, THE NAMED PLAYER, I KNOWINGLY AND FREELY ASSUME ALL SUCH
RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for THE NAMED PLAYERS participation; and,

3. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in THE NAMED PLAYERS readiness for participation and/or in the program itself, I will remove THE NAMED PLAYER from the participation and bring such attention of the nearest official immediately; and,

4. I myself, my spouse, THE NAMED PLAYER, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE THE other participants, sponsoring agencies to include THE VCJCBL, and all officers, employees, representatives, volunteers, sponsors, advertisers, and if applicable, owners and leasers of premises used to conduct the event (“Releasees”), THE VCJCBL, THE JCBL, their officers, representatives, employees, and volunteers, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident THE NAMED PLAYERS involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

5. I, for myself, my spouse, THE NAMED PLAYER, and on behalf of my/our heirs, assign, personal representatives
and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to THE NAMED PLAYER, my spouse, or my/our heirs involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, I FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT.

BY CHECKING THE BOX BELOW, YOU HAVE ACKNOWLEDGED AND AGREED WITH THE ABOVE RELEASE OF LIABILITY STATEMENT.

I/we agree with the above *

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2017 VCJCBL PLAYER REGISTRATION FORM