Softball Clinic 11_09 Registration
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All-Pro Softball Clinic November 8, 2009 SOFTBALL CLINIC REGISTRATION FORM
EMERGENCY INFORMATION
Player’s Name _________________________
In an emergency, if parents cannot be reached please notify:
Age _________________________________ Grade Entering ________________________ Bats: (Circle One)
R
L
Primary Position _______________________ Secondary Position _____________________ * All pitchers must provide own catcher
Name ____________________________________________ Relationship _______________________________________ Phone Number _____________________________________ Doctor ___________________________________________ Doctor Phone # ____________________________________ Known Allergies/Drug Reactions _______________________ _________________________________________________
--------------------------------Parent’s Name _________________________ Street Address_________________________ City _________________________________ State _________
List of Medications Currently Taking ____________________ _________________________________________________
WAIVER AND RELEASE I, the undersigned parent or guardian, understand that Traci Fischer (and staff) and this clinic does not provide medical insurance.
Zip ________________
Email Address_________________________ Phone # _____________________________
I certify that my child is medically cleared to actively participate in the clinic, and do hereby authorize Traci Fischer (and staff) to act for me according to her best judgment in any emergency involving medical treatment in the event that I can not be contacted. I further authorize any attending physician to render any and all medical care which he/she may deem necessary. In consideration of the acceptance of the above named applicant, I, the undersigned parent or guardian covenant and agree with Traci Fischer (and staff), that we will at all times therefore indemnify, keep indemnified, and save harmless Traci Fischer (and staff) from all actions, proceeding, claims, demands, costs, damages, loss of property and expenses, which may be brought against or claimed from Traci Fischer (and staff), or which I may pay, sustain or incur as a result of illness or misadventure to the registrant in this clinic.
___________________________________________________ Parent / Guardian Signature
Date
EMERGENCY INFORMATION
Player’s Name _________________________
In an emergency, if parents cannot be reached please notify:
Age _________________________________ Grade Entering ________________________ Bats: (Circle One)
R
L
Primary Position _______________________ Secondary Position _____________________ * All pitchers must provide own catcher
Name ____________________________________________ Relationship _______________________________________ Phone Number _____________________________________ Doctor ___________________________________________ Doctor Phone # ____________________________________ Known Allergies/Drug Reactions _______________________ _________________________________________________
--------------------------------Parent’s Name _________________________ Street Address_________________________ City _________________________________ State _________
List of Medications Currently Taking ____________________ _________________________________________________
WAIVER AND RELEASE I, the undersigned parent or guardian, understand that Traci Fischer (and staff) and this clinic does not provide medical insurance.
Zip ________________
Email Address_________________________ Phone # _____________________________
I certify that my child is medically cleared to actively participate in the clinic, and do hereby authorize Traci Fischer (and staff) to act for me according to her best judgment in any emergency involving medical treatment in the event that I can not be contacted. I further authorize any attending physician to render any and all medical care which he/she may deem necessary. In consideration of the acceptance of the above named applicant, I, the undersigned parent or guardian covenant and agree with Traci Fischer (and staff), that we will at all times therefore indemnify, keep indemnified, and save harmless Traci Fischer (and staff) from all actions, proceeding, claims, demands, costs, damages, loss of property and expenses, which may be brought against or claimed from Traci Fischer (and staff), or which I may pay, sustain or incur as a result of illness or misadventure to the registrant in this clinic.
___________________________________________________ Parent / Guardian Signature
Date
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