| First Name |
|
| Last Name |
|
| Street Address |
|
| City |
|
| Zip Code |
|
| Phone Number |
|
| Date of Birth |
|
| Height |
|
| Weight |
|
| Medical Condition |
|
| Shirt Size |
|
| Pant Size |
|
| Sock size |
|
| Guardian #1 Name |
|
| Guardian #1 Relationship to Player |
|
Guardian #1 Email (Enter N/A if you do not have one -
By entering my email address, I understand that I may be
contacted throughout the year about other social and
sporting activities for my child.) |
|
| Guardian #1 Cell Phone (Enter N/A if you do not have one) |
|
| Guardian #2 Name |
|
| Guardian #2 Relationship to Player |
|
| Guardian #2 Email |
|
| Guardian #2 Cell Phone |
|
1. I, the parent/guardian of the above-mentioned player,
hereby give my approval to participate in any and all PJB
activities, including transportation to and from the activities. |
Yes
No
|
2. I know that participation in baseball may result in serious
injury and protective equipment does not prevent all injuries
to players, and do hereby waive, release, absolve, indemnify
and agree to hold harmless PJB, Little League, Town of Pendleton,
Park Board, the organizers, sponsors, supervisors, participants,
and persons transporting my child to and from activities
from any claim arising out of any injury to my child whether
the result of negligence or for any other cause. |
Yes
No
|
3. In case of emergency, if our family physician cannot be
reached, I hereby authorize my child to be treated by Certified
Emergency Peronnel. (i.e. EMT, First Responder, E.R. Physician) |
Yes
No
|
4. I agree to return upon request the uniform and other
equipment issued to my child in as good of condition as when
received except for normal wear and tear. |
Yes
No
|
5. I consent for my child to be photographed and/or
videotaped for the purposes of player and sponsor recruitment
and promoting the mission of the Challenger program with the
general public. |
Yes
No
|
6. I agree to have the league do a background check
on me if I am selected to be a volunteer. |
Yes
No
|
7. We have the opportunity to play in 2 or 3 Challenger League
special events/travel games in the Indianapolis area.
Would you be willing to have your child participate? |
Yes
No
|
| |
