2019 Tryout Registration Form

Player Information

Please enter the player's information below.

First Name
*



Last Name
*



Birth Year
*



Street



City
*



State



Player's Phone



Player's Email



Gender
*



Grade



Bats
*

Right
Left


Throws
*

Right
Left


Primary Position
*



Secondary Position
*



Current or Recurring Injuries
*

None
Shoulders
Wrists
Knees
Hips
Feet
Overheating
Asthma / Breathing Problems


Current team playing for:



Other teams played for:



Other Injuries














Parent / Guardian #1

Please enter parent information below.

First Name
*



Last Name
*



Email
*



Home Phone



Work Phone



Cell Phone
*



Would you be interested in coaching?
*

Yes
No













Parent / Guardian #2

Please enter parent information below.

First Name



Last Name



Email



Home Phone



Work Phone



Cell Phone



Would you be interested in coaching?

Yes
No













MEDICAL/EMERGENCY CONTACT INFORMATION



Emergency Contact:
*



Phone
*



Relationship to Player:



WAIVER INFORMATION

In return for my child (Participant) being allowed to participate in the Vipers Fastpitch Tryouts, Practices and/or Games (the Program) I release and agree not to sue the program, its members, and their employees, sub-contractors, sponsors, agents, and affiliates from all present and future claims that may be made by the Participant or me, my family, estate, heirs, or assigns for property damage, personal injury, or wrongful death arising as a result of the Participants participation in the Program, and caused by the ordinary negligence of the parties listed above, wherever, whenever, or however the same may occur. I understand and agree that those listed above are not responsible for any injury or property damage arising about of the Program, even if caused by their ordinary negligence. I understand that participation in the Program involves certain risks, including, but not limited to serious injury. I am voluntarily allowing Participant to participate in the Program with knowledge of the danger involved and agree to accept all risks of such participation. I certify that the participant is in excellent physical health and may participate in strenuous and hazardous physical activities to be played in the Program. I also certify that the participant has permission to be transported by members of the program. Permission is granted for participant to receive emergency medical treatment, if needed. I also agree to indemnify and hold harmless those listed above for all claims arising out of Participants participation in the Program and all related activities. I agree to let the parties use Participants name and likeness free of charge in any manner and for any purpose without compensation to Participant or me. I understand that this document is intended to be as broad and inclusive as permitted by the laws of the state in which the Program is taking place and agree that if any portion of the agreement is invalid, that the remainder will continue in full legal force and effect. I further agree that any legal proceedings related to this waiver will take place in the state of Illinois. I am the parent or legal guardian of the Participant. I am of legal age and am freely signing this agreement. I have read this form and understand that by signing this form, I am giving up legal rights and remedies. I represent that I am parent/legal guardian of the child named above, and agree that the terms of this release are biding on me and the Participant.

Form Submission
*

I Agree with the above waiver and all information submitted is accurate and true.


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