Blacksox Baseball, Salida

Registration Form - All players must fill out each year.

PLAYER INFORMATION
Please only fill out if you have been placed on a team. If you have any questions please call Joel at 209-247-3796.

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

Home Phone:

* Birthdate:

* Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

Home Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

Any medical conditions Coach should be aware of? (i.e. allergies, asthma):

* Phone:

* Relationship to Player:

* Insurance Carrier:

* Policy #:

WAIVER INFORMATION

In case of emergency during any Blacksox Baseball activity I/we authorize emergency medical treatment, as deemed necessary, be rendered to the above-named child. I/we authorize any hospital and/or physician to perform emergency treatment for any injury resulting from any scheduled Blacksox Baseball activity.

We understand that Blacksox Baseball is a competitive travel baseball organization. While Blacksox coaches strive to provide all players with quality playing time, said time is not guaranteed. Playing time is based on attitude, effort, and performance.

Media Release: I/we hereby give Blacksox Baseball permission to use photograph(s) and name of my child on the Blacksox Baseball website or other media.

I/WE understand that participation in baseball may result in serious injuries and that protective equipment does not prevent all injuries to players, and do hereby waive, release, absolve, indemnify, and agree to hold harmless Blacksox Baseball, the organizers, sponsors, participants, and persons transporting my/our child to and from activities for any claim arising out of any injury to my/our child whether the result of negligence or for any other cause, except to the extent and in the amount covered by accident or liability insurance.

I/we agree with the above *

Signature:

Date:

Signature:

Date:

* indicates required fields

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Registration Form - All players must fill out each year.