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E-mail Address<=
/td>
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ress |
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y |
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ephone |
( &nbs=
p;
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of Birth |
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Height |
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ool |
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Insurance No.
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tor |
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Doctor's Teleph=
one |
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| Parent/Guardian |
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Parent/Guardian=
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ress |
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Address |
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y |
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State/Zip |
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State/Zip |
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ephone |
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Telephone |
Home: |
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sp; |
Work: |
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Work: |
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upation |
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Occupation |
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ORGANIZED
BASEBALL HISTORY |
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| Primary =
Position: |
Secondary Positio=
n: |
Bats: R L S |
Throws: R=
L |
| High Sch=
ool Coach: |
Team: |
Phone: |
| Accolades |
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| I=
/We,
the parent(s)/guardian of the above named candidate, give my/our approval=
to
participate in the Connecticut Baseball Academy Program. I/We assume all
risks and hazards incidental to such participation including transportati=
on;
and I/We do hereby |
| w=
aive,
release, absolve, indemnify, and agree to hold harmless the Organizers,
Coaches, Sponsors, and Adult Supervisors, for any claim arising out of an
injury to my/our child, whether the result of negligence or for any other
cause, except to the extent |
| an=
d in
the amount covered by accident or liability insurance. |
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| Parent/Guardian Signature |
Parent/Guardian Signature |
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Date |
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Date |
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| Please Complete Registration Form and mail wi=
th a
$200.00 Registration/tryout Fee to: |
| Team Connecticut Blue Jays=
169
Geduldig Ave Bridgeport CT 06606 |
| www.tcbsouth.com |
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