Hadley Park and Recreation

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Tee ball registration

PLAYER INFORMATION

* First Name:

* Last Name:

Grade:

Street:

City:

State:

Zip Code:

* Phone:

Birthdate:

* Email:

Gender:

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

Emergency Medical Authorization: In the event that I/We cannot be reached in case of an emergency, I/We authorize any/all medical and/or surgical treatments, which are deemed advisable by emergency physicians and/or surgeons for my child. I/We also recognize that the patient when admitted is to remain in the hospital care until his or her physician recommends patient’s discharge. Parent or Guardian also agrees to any photos, which may be taken for Park & Recreation Department use only. In consideration of the time, training and facilities being made available to my child, I understand and agree that any designated instructor, the Town of Hadley, and the Park & Recreation Department shall not be liable to me or my child for any claims, actions, suits or harm that may arise out of, or be in any way related to, my child’s participation in any of the Park & Recreation Programs.

I/we agree with the above *

REQUEST FOR VOLUNTEERS

I am able to volunteer

Signature:

Date:

* indicates required fields

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Tee ball registration