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Sixers Baseball Try Out Registration

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Grade:

School::

Brothers and Sisters (age):

What team did you play on last year?:

Firstname:

PARENT/GUARDIAN #1

Lastname:

EMail:

Work Phone:

Home Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

In the event of illness, permission is hereby granted to any coaching staff member of Sixers Baseball, or their designated representative to administer or secure emergency medical assistance and/or take any other action as may be deemed prudent, including without limitation, referral to licensed medical personnel or transfer to the appropriate hospital or medical facility.

As the parent or legal guardian certify that my son is physically able to participate in Sixers Baseball activities for the current season. The following is a list of all allergies and a list of any current medications that are being taken.

(If NONE, please check the appropriate NO allergies & NO medications)

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

* Allergies:

Yes

Allergies List:

* Medications:

Yes

Medications List:

WAIVER INFORMATION

In consideration of being allowed to participate in any way in the Sixers Baseball program, its related events and activities, I, _______________________________________________the undersigned, acknowledge, appreciate, and agree that:

1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist; and,

2. 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,

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and,

4, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE CONTINENTAL AMATEUR BASEBALL ASSOCIATION AND THE SIXERS BASEBALL TEAM, their officers, agents, and/or employees, other participants, sponsoring agencies, advertisers, and if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE
(UNDER AGE 18 AT THE TIME OF PARTICIPATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next to kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

I/we agree with the above *

Signature:

Date:

Signature:

Date:

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Sixers Baseball Try Out Registration