WINCHESTER ROYALS & SHENANDOAH VALLEY BASEBALL RANCH BASEBALL CLINIC
SATURDAY, JANUARY 31, 2026
CONFIDENTIALITY STATEMENT
Shenandoah Valley Baseball Ranch (SVBR) and The Winchester Royals will keep information contained herein confidential and cannot disclose any related information without the other party’s prior written consent, unless in the case of a medical emergency pertaining to the Athlete(s) on this form.
ATHLETE INFORMATION
Name
*
First Name
Last Name
Nickname (if applicable)
Age
*
Birthday
*
/
Month
/
Day
Year
Date
Phone Number (if applicable)
Please enter a valid phone number.
Email Address (if applicable)
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Sport
*
Baseball
Softball
Other
Batting/Throwing Arm(s)
*
Ex. Left/Right
Position
School
Favorite Team, Player, etc.
Ex. Washington Nationals, Babe Ruth
Medical Conditions, Allergies, or Past Injuries (Type "N/A" or "None" if not applicable)
*
Ex. Asthma, Peanut Allergy, etc.
Select Your Session Time for Athlete
*
8:00-10:30 AM (Ages 8-12)
11:00 AM-1:30 PM (Ages 13-18)
Is there another athlete from the same household participating in this clinic?
*
Yes
No
ATHLETE #2 INFORMATION
Type "N/A" or "None" in the required fields below if this section is not applicable. This Athlete must live in the same household as the first Athlete.
Name
*
First Name
Last Name
Nickname (if applicable)
Age
*
Birthday
*
/
Month
/
Day
Year
Date
Phone Number (if applicable)
Please enter a valid phone number.
Email Address (if applicable)
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Sport
*
Baseball
Softball
Other
Batting/Throwing Arm(s)
*
Ex. Left/Right
Position
School
Favorite Team, Player, etc.
Ex. Washington Nationals, Babe Ruth
Medical Conditions, Allergies, or Past Injuries (Type "N/A" or "None" if not applicable)
*
Ex. Asthma, Peanut Allergy, etc.
Select Your Session Time for Athlete 2
*
8:00-10:30 AM (Ages 8-12)
11:00 AM-1:30 PM (Ages 13-18)
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PARENT/GUARDIAN INFORMATION
Only athletes that are 18 years of age may choose to input their personal information in this section.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
INSURANCE INFORMATION
Insurance Company
*
Ex. Aetna, Anthem, Blue Cross Blue Shield, etc.
Insurance Member ID/Policy Number
*
Policy Holder's Full Name
*
First Name
Last Name
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*
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( X )
INDIVIDUAL ATHLETE
$
150.00
TWO ATHLETES
Athletes must reside in the same household
$
250.00
By signing, I understand that photos and/or videos of the above mentioned Shenandoah Valley Baseball Ranch (SVBR) x Winchester Royals Baseball Clinic will occur and hereby grant permission to SVBR and The Winchester Royals to use any photos and/or videos of my Athlete taken during the SVBR x Winchester Royals Baseball Clinic for either organization's marketing efforts and communications, either by print or online. I also understand that participation in this clinic involves physical activity that may expose me/my child to risks, including but not limited to injuries such as sprains, fractures, and other potentially severe conditions. I assume all risks associated with participation in this clinic and hereby release, waive, discharge, and covenant not to sue or defame the organizers of this clinic, including but not limited to its employees, coaches, volunteers, and any affiliated entities, specifically Shenandoah Valley Baseball Ranch LLC, Winchester Royals Inc., Blue Ridge Baseball Association, and Adrian Pullen from any and all claims, liabilities, or damages from my/my child's participation in the clinic. In the event of a medical emergency, I authorize the clinic organizers to seek medical treatment for me/my child, and I agree to be responsible for any medical expenses incurred.
*
Payment Methods
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make your payment.
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