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Louisiana Fever
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Registration
PLAYER INFORMATION
*
First Name:
*
Last Name:
Street:
City:
State:
Zip Code:
*
Home Phone:
*
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
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21
22
23
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25
26
27
28
29
30
31
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
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2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
*
Email:
*
Gender:
M
F
*
Grade:
K
1
2
3
4
5
6
7
8
9
10
11
12
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 WAIVER OF LIABILITY & MEDICAL RELEASE
As the parent or guardian I warrant, represent and agree that the player is in good physical condition and that the player has no disability, impairment or ailment that prevents him or her from engaging in active or passive exercise that will be detrimental to his health, safety, comfort or physical condition if he does so engage or participate. It is recommended that everyone consult their own physician before beginning any exercise program.
I hereby give my approval for the above-named player to participate in any and all baseball or softball activities, including transportation to and from the activities.
Medical Release: I hereby grant permission to the adult manager, coach, trainer, board member, team administrator, business manager, or any other adult volunteer of the team to obtain medical care, at my expense, from any licensed physician, hospital or medical clinic, for the player named herein at such time as either parent or legal guardian cannot be contacted in person or by telephone, or if immediate medical attention deemed necessary prior to contacting a parent or legal guardian. This authorization shall include all team activities, including the period required to travel to and from these activities. I know that participation in this sport may result in serious injuries and protective equipment does not prevent all injuries to players and I do hereby waive, release, absolve, indemnify, and agree to hold harmless the Louisiana Fever organization, the organizers, supervisors, participants, and persons transporting the player to and from those activities, for any and all claims arising out of an injury to the player whether the result of negligence or for any other cause.
I/we agree with the above form
*
*
Please List any Medical Limitations.:
*
Parent, Guardian or Adult E-mail:
* indicates required fields