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Online Forms
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Sponsorships!
Selma Athletic Club
Scorcher Baseball
A TRADITION OF EXCELLENCE
2009-2010
SPONSORSHIP APPLICATION
SPONSORS NAME_________________________________________
Business Name _____________________________________________
Address _________________________________________________
Web Address__________________________________________
Contact Phone______________________email_____________________
Player being sponsored________________________________________
Please check the following: TaxID# 02-062-9020
___Platinum- 100.00
___Gold- 50.00
___Silver- 25.00
___bronze-10.00
Thank you for your generosity. If you have any questions, please call MIKE LUJAN (www.leaguelineup.com/mikelujan) Please be sure to enclose a check payable to “Selma Athletic Club”. Please mail your check to:
Selma Athletic Club
3171Mulberry st.
Selma Ca, 93662
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Club Waivers and Release Forms
Selma Athletic Club Waiver and
Release of Liability / Medical Consent
NOTE: All Participants/Parents must read and sign this form before participating in Baseball events.
In consideration of being allowed to participate in any way with the Baseball program, I, the undersigned acknowledge, appreciate, and agree that:
1. I risk bodily injury, including paralysis, dismemberment, disability and death, and while particular rules of sport, skills, equipment, and personal discipline may reduce the risk, this risk of serious injury does exist, as well as the risk of damage to or loss of property; and,
2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions of participation. If, however, I observe any unusual significant hazard during my presence or participation or if I observe any concern in my readiness for participation, I will immediately bring such to the attention of the nearest official and remove myself from participation; and,
4. I, for myself, and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release, indemnify, hold harmless and promise not to sue Selma Athletic Club, their officers, officials, volunteers, employees, agents, and/or other participants, sponsors, advertisers, and, if applicable, the lessors of premises used for the activity (“Releases”), with respect to any and all injury, disability, death, and/or loss or damage to person or property, whether caused by the negligence of the releases or otherwise, except that which is the result of gross negligence or wanton misconduct, to the fullest extent permitted by law.
I have read this Release of Liability and Waiver Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.
Participant’s Signature: ________________________________________ Age: ________________
Participant’s Name (Print): _____________________________________ Date: _____________
For Parents/Guardians of Participants of Minority Age (under 18 yrs of age)
This is to certify that I/we, as parent(s)/guardian(s) with legal responsibility for this participant, do consent and agree not only to his/her release, but also for myself/ourselves, and my/our heirs, assigns and next of kin to release and indemnify the Releases from any and all Liability incident to my/our minor child’s involvement as stated above, even if arising from the negligence of the releases, to the fullest extent permitted by law.
Parent/Legal Guardian Signature: ___________________________ Date Signed: ___________
Parent/Legal Guardian Name (Print): ________________________ Emerg. Ph: ____________
Parent/Guardian Medical Consent
In the event of an accident or other emergency, when a parent or guardian is unavailable, I hereby authorize a member of the Selma Athletic Club staff to make such arrangements as they consider necessary for my child to receive medical or hospital care and transportation. Under such circumstances, I further authorize the physician named below to undertake such care and treatment of my child as he/she considers necessary. In the event the below-named physician is not available, I authorize such care/treatment be performed by any licensed physician or surgeon. The undersigned hereby agrees to bear all costs incurred as a result of the forgoing.
Parent/Guardian Signature: _____________________________________ Date:____________
Parent Home Phone Doctor Name__________________________________________________
Cell/Alternate Phone Doctor Phone_________________________________________________
Parent address/city/zip Preferred Hospital____________________________________________
Emerg. Contact Name Insurance Carrier_____________________________________________
Emerg Contact Phone Group Acct No. ______________________________________________
Please check any limiting factors that apply:
__Wears glasses __Hearing __Asthma __Diabetes List allergies _________________________________
Comments ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Player Profile
SELMA SCORCHERS
PLAYER PROFILE
1. LAST NAME;___________________________________________
2. FIRST NAME:____________________________________________
3. DADS NAME:_________________________________________
4. MOMS Name:___________________________________________
5. PLAYERS EMAIL:_________________________________________
6. PARENTS EMAIL:______________________________________
7. PLAYERS PHONE #:_______________________________________________
8. PARENTS #:_____________________________________________
9. ADDRESS:_________________________________
10. CITY:____________________________________
11. SCHOOL:_________________________________
12. DATE OF BIRTH/YOUR AGE TODAY:__________________________________
13. GRAD DATE:____________________________________________
14. PRIMARY POSITION:_______________________________________
15. SECONDARY AND ANY OTHER POSITION:_____________________________
16. BATS:___________________________________
17. THROWS:__________________________________
18. WHAT ARE YOUR GOALS AS A BALL PLAYER?_________________________
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Thank you's
SELMA SCORCHERS
A TRADITION OF EXCELLENCE
2009-2010
DEAR SPONSOR,
On behalf of the Selma Athletic Club baseball program, I would like to Thank you very much for becoming a team sponsor! Your contribution is very much appreciated. Your contribution will go a long way to help the players on our team reach our goals.
Please keep this letter for your records as a verification of your contribution. The Selma Athletic Club Tax ID# 02/062/9020.
We will post information about our schedule when it becomes available on our web site@ www.leaguelineup.com/mikelujan. It is our hope that you will come out and see us play soon.
Thanks again,
MIKE LUJAN
JESS MONTEMAYOR
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