REGISTRATION FORM

Select the clinic(s) that you will attend:

First Name

Last Name

Age

Birthdate

Address

City

State

Zip

Home Phone

Cell Phone

Email

T-Shirt Size?

Promotional Code or Name of Person Who Referred You

Operations or serious Injuries (with dates)

Disabilities - chronic or recurring illness

Any activities to be limited by doctor's advice

Current Medications

Allergies/Dietary Restrictions

Do you now play in a league?
 MSBL NABA Roy Hobbs

Other

If yes, for how long?

If you don't play in a league, when was the last time you played baseball?


Defensive Position:

1st Choice:

2nd Choice:

Bats:
 Right Left

Throws:
 Right Left

Hotel Reservation:
 Single Double

What do you most want to learn from this clinic?


CONFIDENTIAL MEDICAL INFORMATION

Emergency Contact

Name

Relationship

Phone (Day)

Phone (Night)

Primary Physician(s)

Name

Phone

Name

Phone

Insurance Information

Name

Policy #

Group #

Phone


MEDICAL WAIVER

This document establishes my desire to participate in the Pro Ball Baseball Clinic ("event"). I hereby represent that I am physically capable of participating in and completing this activity and that I have had the opportunity to, and have been advised to consult my doctor(s) regarding any physical and/or medical condition which might be effected by or effect my participation herein. If I am aware of or under treatment for any physical and/or emotional infirmity, ailment or illness, my medical care provider knows of my condition has approved of my participation in this event.

I acknowledge that I, and I alone, am solely responsible for my personal health and safety. I further agree that my participation in the event is subject to the sole discretion of the organizers of the Pro Ball Baseball Clinic, and that my participation may be limited for medical and/or other health and safety reasons. In the event that any injury precludes me from making a rational decision regarding my health care and treatment, I authorize the Director of the Pro Ball Baseball Clinic to act in his best judgment in such emergency cases, and I hereby waive any claim against Pro Ball Baseball Clinic for so acting.

Should medical treatment become necessary as a result of my participation in said event, I assume all financial and legal costs related to emergency medical treatment and/or hospitalization, and I hereby agree to indemnify, defend and to hold Pro Ball Baseball Clinic harmless from any such costs so incurred.

I further state and affirm that the above statements are true and correct and printing of my name constitutes my electronic signature

Print Participant Name


WAIVER OF NEGLIGENCE, COMPLETE RELEASE OF LIABILITY & ASSUMPTION OF RISK

I wish to participate in the Pro Ball Baseball Clinic (the “event”), a dba under Voice Doctor, Inc.” I understand that in participating in said event, I will be using facilities where inherent hazards exist and I am aware and appreciate the health risks and injuries that may result. I am aware that the risk of injury from my participation in the activities involved in this event is significant, including the potential for permanent paralysis and death, and while particular rules, equipment and personal discipline may reduce this risk, the risk of serious injury or death does exist. Concurrently herewith, I have presented a MEDICAL WAIVER from, the contents of which are incorporated herein by reference, and I affirm that all representations made by me which are contained therein are true and correct.

By participating in the Pro Ball Baseball Clinic, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my participation. I am voluntarily participating in the Pro Ball Baseball Clinic with knowledge of the dangers involved and I agree to accept all risks of injury, including death.

In consideration for being permitted by the Pro Ball Baseball Clinic and Voice Doctor, Inc. to participate in the Event, I agree to assume all risks and to release, indemnify, defend and hold the Pro Ball Baseball Clinic, Voice Doctor, Inc., a California corporation, its designated beneficiaries, sponsors, advertisers and officers, as well as the City of Peoria, AZ and and/or Pittsburgh Associates, harmless for any claimed act(s) of negligence, carelessness, or any other cause by which such persons and/or entities might be liable to me, or by which I, or someone on my behalf, might assert any basis of liability or fault.

I further intend by this Waiver of Negligence & Complete Release of Liability to release, in advance, and to waive my rights and to discharge all of the persons and entities mentioned above, from all claims for damages for death, personal injury and/or property damage that I may have, or which may hereafter accrue to me, (including my heirs and assigns), as a result of my participation in this event, even though such liability may arise from negligence, or carelessness on the part of the persons or entities being released, and/or from dangerous or defective property or equipment owned, maintained or controlled by them because of their possible liability without fault.

I understand and agree that this Waiver of Negligence & Complete Release of Liability is binding on my heirs, assigns, personal representatives, next of kin and legal representatives.

I have read this Waiver of Negligence & Complete Release of Liability & Assumption of Risk Agreement. I fully understand its terms and understand that I have given up substantial rights by signing it. I sign this document freely and voluntarily without any inducement.

Print Name

Date

Signature

By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.