Registration Form

Registration Form
Name of Student*

First NameLast Name
Little League
Please indicate what type of instruction you are interested in.
Private / Semi-private / Clinics
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent / Guardian Contact Information
Parent / Guardian *

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
Relation to Student

Photo Waiver Release
I hereby grant the LV Pitching Performance permission to use photographs in any of the following:

• Web-based publications

• Print Advertisements

• Organization Bulletin
Name of student*

First NameLast Name
I hereby acknowledge that by submitting this form I affirm that such release to the LV Pitching Performance, herein after referred to as the releasee, does not constitute any form of compensation, including royalties arising from the photographs, to my benefit.

I understand and agree that photographs in the possession of the releasee shall become the property of the releasee. The use and publication of the photographs however, shall conform to my rights as a subject of said photographs.

I hereby waive my right to inspect of approve the photographs by which the likeness of the aforementioned student appears.

I hereby hold harmless, release, and forever discharge the from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
Name Parent / Guardian giving consent*

First NameLast Name
Should be Empty: