HUB Baseball Academy - Summer 2023

HUB Baseball Academy

SUMMER 2023 AT THE HUB
Co-Ed Baseball Academy for Boys & Girls ages 2nd-6th grades
- Tball & Coach pitch; learn basics like catching, batting, pitching
- FREE to join for 74127 residents; all equipment provided
- Please wear close-toed shoes; no flip-flops or sandals
- Academy is held weekly from July 11 to August 17:
- 2nd & 3rd Grades > Tuesdays 5-6:30pm, starting July 11
- 4th-6th Grades > Thursdays, 5-6:30pm, starting July 13
- Academy held at The Hub fields >> 19 S. 49th West Ave
- Questions? Email Athletics Program Manager, Massiel Anguiano at massiel@cgtulsa.org
- To participate, please register below
Parent / Guardian:*

First NameLast Name
Relation to Child(ren):*
Parent / Guardian email:*
Please enter a valid email address.
Parent / Guardian Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Please enter your child(ren)'s information below.*
Number of children you are registering on this form:
My child received a flier at Summer CampI received an email from The HUB or picked up a flier thereI saw info on social media (Facebook, Instagram)I saw info on websiteI saw info on an email newsletter I receivedOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Legal Guardian #2:

Full NameRelation to Child
Parent / Legal Guardian #2 Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Parent / Legal Guardian #3:

Full NameRelation to Child
Parent / Legal Guardian #3 Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Parent comments/concerns:

MEDICAL RELEASE AND AUTHORIZATION FORM
In case of emergency, contact:*
Full Name
Emergency Contact Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
YESNO; my child has NOT participated in sports at The HUB in 2023.
YES, there is one on file for Athletics programs; If 'YES' please skip to the next pageNO; If 'NO' please complete the Medical Release & Authorization Form below.
Family Physician:
Physician Phone #:
Please enter a valid phone number.Format: (000) 000-0000.
Physician Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Allergies (Please list child's name and allergy):
Currently taking the following medication & reason for taking medication (Please list child's name and medication):
Please list any current or past medical conditions/injury to be aware of:
Medical Insurance Company:
Policy #:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Family Dentist:
Dentist Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Dental Insurance Company:
Policy #:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Prescription Insurance Company:
Policy #:
I hereby authorize the Staff/Trainers of The Common Good Tulsa to act for me according to their best judgement in any emergency requiring immediate medical attention, and I hereby waive and release the Staff/Trainers of The Common Good Tulsa from any/all liability for injury/illness incurred while attending this training session. I have no knowledge of any physical impairment that would be affect my participation in the session as outlined in the information *

In case of emergency, I hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any.

Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs.

This authorization and permission form is valid for all The Common Good activities for the 2023 summer season - June 01 to September 01, 2023.
Parent / Guardian Name:*
Parent / Guardian Signature:*
Date*

MonthDayYear
Date

Release Form for Media Recording

I, the undersigned, do hereby consent and agree that The Common Good, its employees, Board members, volunteers, and agents have the right to take photographs, videotape, or digital recordings of me and use these in any and all media, now or hereafter known, and exclusively for the purpose of advertising or promoting The Common Good or any entities with which we partner. I further consent that my name and identity may be revealed therein or by descriptive text or commentary.

I do hereby release to The Common Good, its Board, employees, volunteers, and agents all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used.

I understand that there will be no financial or other remuneration for recording me, either now or in the future.

I also understand that The Common Good is not responsible for any expense or liability incurred as a result of my participation in this recording.

I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.

I hereby authorize The Common Good Tulsa, to use any pictures, video or other marketing material of me for promotional purposes or advertising as deemed appropriate. *

For children under 18 years of age, Parent/Guardian Name signature is required:
Yes, I agreeNo, I do NOT authorize the media release
Parent/Guardian Signature:*
Date*

MonthDayYear
Date

THE COMMON GOOD

RELEASE OF LIABILITY FORM

In consideration of my child participating in The Common Good’s Learning Center activities. We/I, do for ourselves (myself) and for and on behalf of my/our child-participant do hereby release, forever discharge and agree to hold harmless The Common Good and its employees, Board members, volunteers, and agents thereof from any and all liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and child-participant that occur while said child is participating in the activity sponsored by The Common Good.

Furthermore, We/I and for and on behalf of our/my minor child-participant if under the age of 21 years hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participating in recreation and work activities involved therein.

The undersigned further hereby agree to hold harmless and indemnify The Common Good, its employees, board members, volunteers, and agents, for any liability sustained by The Common Good as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereof.
Parent / Guardian Full Name:*
Parent / Guardian Signature:*
Date*

MonthDayYear
Date
I HAVE READ THE FOREGOING AND UNDERSTAND THE BEHAVIORAL COVENANT FOR PARTICIPANTS AND WILL ABIDE BY THEM AS WELL AS THE DIRECTIONS OF THE LEADERSHIP OF THE COMMON GOOD’S LEARNING CENTER ACTIVITIES.
Should be Empty: