Spring 2025 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 * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal What dates will the player participate in baseball? Select as many as apply. * May 10 May 17 May 31 June 7 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 signature keyboard Clear Date * Submit If you are human, leave this field blank.
