All Star Baseball Combo Clinic 12/13/24

Purple Victory Camps/Clinics- Registration Form

www.purple-victory.com

Athlete Information

Player Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Current Grade*

Age*

High School

Graduation Year*

Travel Team

Primary Position*

Secondary Position

Parent/Guardian *

First NameLast Name

Cell Phone*

Area CodePhone Number

E-mail*

PURPLE VICTORY TOTAL SKILLS CLINIC LIABILITY FORM

I wish to participate in the Purple Victory softball total skills clinic/camp. I am informed that the activities are conducted by individuals who work for or may volunteer their services to the program. I recognize that risk of accident and/or injury are possible consequences of participation in any activity, and that no amount of reasonable instruction and supervision will prevent every and all type of injury. I also realize and understand that severe injuries are possible. I appreciate the character of the risks involved and I voluntarily assume all risk of injury. I have carefully considered how the possible consequences of injury may impact my life and choose to accept this risk and to participate in the designated activities. In accepting this risk, I expressly and explicitly release, discharge and waive any and all responsibility of Purple Victory and the employees, officials or agents of any and all of the foregoing, pertaining or related to, or arising from, in any manner, injuries to my person as a result of participation in this activity.

Purple Victory strongly recommends that valuable personal items not be brought to any camp/ clinic. Purple Victory hereby disclaims any liability or responsibility in the event a personal item is lost, stolen, or damaged. By participating in a Purple Victory camp you hereby waive, release and acquit Purple Victory from any liability, claim or responsibility of whatever nature arising out of the loss of or damage to any personal property. I, as parent/guardian for the camper listed above, state that I am the natural parent and/or have legal custody of the camper listed. I authorize (head coach/camp director) to consent to any examination, anesthetic, x-ray, medical or surgical diagnosis or treatment, and/or hospital care to be rendered to this minor under the general conditions of special supervision and on the advice of any physician or surgeon licensed to practice when efforts to contact me are unsuccessful. This consent form is granted for the full period of the camp/ clinic.

I have read and agree to the above conditions*

YesNo

Date*

Date

Emergency Contact Information

Emergency Contact's Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship*

My Products

Combo (for Pitchers or Catchers that Play Secondary Position $165.00

All Star Baseball Academy Prospect Clinic/ Grades 8-12 / 5:00-9:00 PM/ December 13, 2024

Enter coupon

Total $0.00

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