CB SMOKE FASTPITCH

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14U Registration 2022-23

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

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

As the parent/legal guardian of the above-named player, or player age 18 or over by signing I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent. I agree to hold harmless CB Smoke Fastpitch, City of Richland, its agents, employees, coaches and other players. I hereby release them from any liability on account of injuries sustained by the player while participating in any activities. I understand that my insurance company, or I, will accept all medical expenses. I have read and understand the above. I also acknowledge that players will be notified of team selection via the team manager or head coach after the tryouts and accept that the decision of CB Smoke Fastpitch.

Parent/Guardian acknowledgement is required for participation in tryouts.

I/we agree with the above *

* Pitch (Yes/No):

* Catch (Yes/No):

* Bats/Throws:

* Top 3 Positions:

* indicates required fields

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14U Registration 2022-23