2017-2018 Registration and Medical Release Form

Player Information (required)

Player Name Player Date of Birth (mm/dd/yyyy)

Player Street City Zip

Parent/Guardian Information (required)

Parent Name

Street City Zip

Parent/Guardian Phone Parent Email

Emergency Contact Information (required)

Emergency Contact Name Emergency Phone

Medical Insurance Information

Medical Insurance Provider

Policy # Expiration Date:

List Any Medical Conditions

The undersign acknowledges that the activity may involve risks and the undersigned assumes the risk of any and all bodily injury and all property loss or damages arising in any way from said activity. The undersigned agrees that Advantage Baseball is not in any way a guarantor of safety in connection with the activity.

As parent or legal guardian of below applicant, I authorize Advantage Baseball to request medical treatment as necessary to insure the well being of the applicant. We, the undersigned, for ourselves, or heirs, executors and administrators, waiver and release forever discharge Advantage Baseball, their staff, officers, agents representatives, employees successors, and assigns of and from any and all rights claims for damages to persons or property which may be sustained or occur during participation in activities, to or from program, whether paid damages, injury are due to negligence or not.

The undersigned is not relying upon Advantage Baseball for any manner of insurance for protection in connection with this activity. The undersigned shall be responsible for providing all insurance to be relied upon for protection in connection with this activity and the undersigned shall not hold Advantage Baseball responsible for providing any insurance coverage.

Check this box to accept and agree to these terms.

Signed By (Type Name) Date