All-Pro
Softball Clinic
November 8, 2009
SOFTBALL CLINIC REGISTRATION FORM
Player’s Name _________________________
Age _________________________________
Grade Entering ________________________
Bats: (Circle One) R L
Primary Position _______________________
Secondary Position _____________________
* All pitchers must provide own catcher
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Parent’s Name _________________________
Street Address_________________________
City _________________________________
State _________ Zip ________________
Email Address_________________________
Phone # _____________________________
EMERGENCY INFORMATION
In an emergency, if parents cannot be reached please notify:
Name ____________________________________________
Relationship _______________________________________
Phone Number _____________________________________
Doctor ___________________________________________
Doctor Phone # ____________________________________
Known Allergies/Drug Reactions _______________________
_________________________________________________
List of Medications Currently Taking ____________________
_________________________________________________
WAIVER AND RELEASE
I, the undersigned parent or guardian, understand that Traci Fischer
(and staff) and this clinic does not provide medical insurance.
I certify that my child is medically cleared to actively participate in
the clinic, and do hereby authorize Traci Fischer (and staff) to act
for me according to her best judgment in any emergency involving
medical treatment in the event that I can not be contacted. I fur-
ther authorize any attending physician to render any and all medical
care which he/she may deem necessary.
In consideration of the acceptance of the above named applicant, I,
the undersigned parent or guardian covenant and agree with Traci
Fischer (and staff), that we will at all times therefore indemnify,
keep indemnified, and save harmless Traci Fischer (and staff) from
all actions, proceeding, claims, demands, costs, damages, loss of
property and expenses, which may be brought against or claimed
from Traci Fischer (and staff), or which I may pay, sustain or incur
as a result of illness or misadventure to the registrant in this clinic.
___________________________________________________
Parent / Guardian Signature Date