Saturday, September 12th- October 18th!
Buddy's Name
First Name
Last Name
Buddy's age
Guardian/Parents name
First Name
Last Name
Home Phone
*
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
House #/Street Name
*
Town
Postal Code
*
E-mail
*
Time slot.
Saturday 10:00-11:00 am
Saturday 11:00-12:00
Sunday 10:00-11:00
Sunday 11:00-12:00
Sunday Skills 12:30-1:30
Interested in Coaching?
*
Yes
No
Assistant Coach
Comments
Release form
In consideration for the Miracle League of Westchester, Inc. providing the opportunity for this consumer to participate in Miracle League baseball, the undersigned does hereby release and agree to indemnify and hold harmless the Miracle League of Westchester, Inc and its officers and directors from any and all claims for personal injury, death, property damage, or any type of claim or damage (including but not limited to attorney's fees or litigation expenses) resulting from this consumer’s activities in connection with participation in Miracle League baseball or the participation of any family member or guest of the undersigned. We assume all risks and hazards incidental to such participation in Miracle League games and activities and consent for this consumer to receive first-aid and/or emergency care by a qualified Emergency Medical Technician or physician or other person qualified to render medical assistance in the event this consumer suffers an injury during sanctioned games and activities. I agree to provide this consumer’s specific medical information to the Miracle League of Westchester, Inc. so that appropriate precautions and care can be provided to this consumer during sanctioned games and activities. We agree to be present at all games and activities so that we can manage this consumer’s specific needs. We agree to have any and all medication (prescription and nonprescription) for this consumer and shall be solely responsible for dispensing any such medication to this consumer. We understand that there will be media and promotional coverage of Miracle League Games and activities and We give our consent to publish this consumer’s name and picture for such purposes
Digital Signature . I have read and accepted the rules, regulations and release information provided in this registration
*
First Name
Last Name
Donate
prev
next
( X )
USD
thank you for your generosity
loading smart payment buttons...
The payment is ready! It will be completed once you submit the form.
Submit
Print Form
Should be Empty: