Adaptive Baseball - Player Registration

Child's First and Last Name

Child's Age

Child's Date of Birth

Example: January 7, 2019

Parent/Guardian's First and Last Name

Parent/Guardian Email

Parent/Guardian Phone Number

Address

City

State/Province

Zip/Postal

What dates will the player participate in baseball? Select as many as apply.

Sept. 13

Sept. 20

Sept. 27

Oct. 4

Check all that apply

Is your child in need of a "buddy"

YES

NO

What type of support/assistance would make this activity a success for your child?

Emergency Contact Information

Contact's name

Contact's Phone Number

Contact's Relationship to Family

Release

Publicity Release

The Children's Center for Communication/Beverly School for the Deaf (CCCBSD) takes pride the achievements and activities of its students, families, and community members. As part of standard practice, media are used on a regular basis. These may include photos and/or videos shared as hard copy or electronically. CCCBSD will never post names within media, including social media or websites. CCCBSD does not take responsibility for images taken of your child by individuals not affiliated with CCCBSD. Further, I release CCCBSD, its Board of Trustees, employees, and other representatives from any known liabilities, known or unknown, arising out of the use of these materials. I understand and accept the publicity policy.

Liability Release

I give my child permission to take part in the Community Sports program at CCCBSD. I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for disability, personal injury, or property damage for THE FOLLOWING ENTITIES OR PERSONS: The Children’s Center for Communication/ Beverly School for the Deaf and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that The Children’s Center for Communication/ Beverly School for the Deaf and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I hereby consent to medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. THIS WAIVER WILL BE EFFECTIVE FROM THE SIGNED DATE BELOW AND MOVING FORWARD.I assume all risks and hazards incidental to such participation in basketball games and activities. I/we agree to be present at all games and activities so that I/we can manage our child's specific needs. I agree to be solely responsible for my child

Electronic Signature

Parent/Guardian Electronic Signature

Clear

Date

Adaptive Baseball – Player Registration

Emergency Contact Information

Release

Electronic Signature

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