Team Virginia Mizuno Premiere Team Tryout Registration

Player Name*

First NameLast Name

Player Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Player Email*

example@example.com

Player Date of Birth*

Date

Player Graduation Year*

Primary Position*

Secondary Position*

Please write why you should be chosen to represent Team Virginia Mizuno on the Premiere team. *

Mother's Name

First NameLast Name

Mother's Email

example@example.com

Mother's Cell Number

Area CodePhone Number

Father's Name

First NameLast Name

Father's Email

example@example.com

Father's Cell Number

Area CodePhone Number

AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT

By submitting this form you give your consent for your child's participation in any and all Team Virginia Athletics Mizuno functions or activities. In the event of any injury or sickness occurring during any Team Virginia Athletics Mizuno functions or activities, you authorize any official(s) to administer first aid and if necessary to transport your child to the nearest emergency treatment facility.

You release Team Virginia Athletics Mizuno and any person(s) connected with Team Virginia Athletics Mizuno Organization of any responsibility from accident or injury incurred as a result of her participation in any and all activities, including transportation to and from any Team Virginia Athletics Mizuno functions or activities.

You certify that you child has been given a physical examination and is physically able to participate in all related activities. Please notify in writing any prescribed medications and / or physical conditions of which the Team Virginia Athletics Mizuno coaching staff or assistants should be aware of are listed below.

You also acknowledge and agree that all related medical costs are your responsibility.

Signed: Parent/Guardian or Player 18 years of age *

Team Virginia Mizuno Premiere Baseball Tryout Registration