Palmer Softball Association – Under 18 Consent Form

Name:  ______________________________________________

Date of Birth:  ___________________(mm/dd/yy)         Age:  ______________

Team:  ______________________________________________

Address:  ____________________________________________________

City:  ______________________________   State:  _____    Zip Code: __________

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In consideration for the Palmer Softball Association (PSA) providing the opportunity for the above named minor the opportunity to play softball in the leagues, the undersigned parent/guardian and authorized adult do hereby release and agree to indemnify and hold harmless the PSA and its officers and Palmer Township from any and all claims for personal injury, death, property damage, or any type of claim or damage resulting from the minor’s participation in PSA league/tournament games or activities.  As a parent/guardian of the named child I assume all risks and hazards incidental to such participation and consent for my minor to receive first-aid and/or emergency care in the event my minor suffers an injury during sanctioned games or activities.

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Parent/Guardian Name (Print)                              Parent/Guardian Signature

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Date Signed