Emergency Contact Number: ___________________________________________________________ |
Medical Comments: __________________________________________________________________ |
Special Request: _____________________________________________________________________ |
Planned Vacation Date: ________________________________________________________________ |
Responsibility: |
The participant is responsible for his or her own medical coverage. I agree that this Association will not be liable for any injuries I (or my child) receives while participating in or attending at a game or a practice and I further agree not to make any claim or take any proceedings against any other persons or corporations which might claim contribution from or indemnity against the Association under any statue or otherwise. I hereby promise to obey all rules of the Association, to take proper care of the Association;s equipment and to be responsible for loss or damage to such equipment.
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Please circle where you can help: Coaching Assistant Coach Umpire Sponsor
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| Other:____________________________________________ DATE:____________ |
Volunteer's Name: ______________________ Phone No: __________________________
Player's signature: _____________________ Parent's signature: ______________
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