Sandwich Girls Softball 2010 Registration Form
| First Name | |||
| Last Name | |||
| Address | City: | Zip : | |
| Birth Date | |||
| Age (as of 9/1/10) | |||
| Current Grade |
Parent/Guardian Information
| Mother's Name | |
| Address, if different | Phone: |
| Father's Name | |
| Address, if different | Phone: |
| Emergency Contact: | Phone: |
| Parent/Guardian Email: |
Please provide the following information:
| Age Division: | ||
| Jersey Size: | ||
| Returning Players Only: | Prior Year Coach: | Return to this Coach? Yes No |
All Players: Please provide comments (if any) we should be aware of when placing participant on teams:
Payment Information
| Fees (In-District) | 8U $35 each | 10U through 17U $50 each | Family Max $100 |
| Fees (Out-of-District) | 8U $52 each | 10U through 17U $75 each | Family Max $150 |
| PLUS $50 Refundable | Concession Fee | Please bring in separate check & sign concession form | |
| Total Due: |
Credit Card : Credit Card Number: V-Code:
Expiration:
Waiver and Release of All Claims
As a participant in the above program, those listed above recognize and acknowledge that there are certain risks of physical injury and those listed above agree to assume the full risk of any injuries, including death, damages or loss which those listed above sustain as a result of participation in any and all activities connected with or associated with such programs. Those listed above agree to waive and relinquish all claims those listed above may have as a result of participation in the program, against the Sandwich Park District, its officers, agents, servants and employees. Those listed above hereby fully release and discharge the Sandwich Park District and its officers, agents, servants and employees from any and all claims from injuries, including death, damage or loss which may accrue to those listed above on account of participation in the program.
Those listed above further agree to indemnify and hold harmless and defend the Sandwich Park District and Sandwich School District #430 and its officers, agents, servants and employees from any and all claims resulting from injuries, including death, damages and losses sustained by those listed above arising of, connected with, or in any way associated with the activities of the program.
I have read the above recreation waiver and release of all claims, and understand that my signature is required below in order to participate in the Sandwich Park District programs. Signature is required of all participants 18 years or older and of parent/guardian for those participants under 18 years of age.
In the event of any injury or acute illness while participating in the Sandwich Park District Girls Softball program, I, as a parent/guardian, give the staff at the Sandwich Park District authorization to approved first aid treatments, x-ray examinations, anesthetic, medical and surgical treatment, and any other hospital care that may be needed for the participant named above. I, the undersigned, realize that if the participant is injured during the Sandwich Park District Girls Softball program, the Sandwich Park District, its commissioners, staff and volunteers cannot and will not be responsible for the costs incurred, nor liable for damages which may result to protect the participant.
Parent/Guardian Signature Today's Date: