Clone of 2025 PAL Baseball Clinic

Name

First NameLast Name

Birth Date

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

T-Shirt Size

Phone Number

Format: (000) 000-0000.

Is there a specific topic you would like us to cover?

I hereby certify that the staff of the Glassboro Police Department to act for me according to their best judgement in any emergency requiring medical attention, and hereby waive and release the clinic from any and all liability for any injury or illness incurred while at the clinic. I have no knowledge of any physical impairment that would be affected by the above named person's participation in the clinic.

I hereby give permission to the Glassboro Police Department to take photos of my child and use them on their social media platforms.

Parent/Guardian Name

First NameLast Name

Parent/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Email

example@example.com

Signature

Phoenix Rising