Fredericksburg: Del Voight delvoight@gmail.com 717 821-0699
Jonestown: Chuck Fager chuckfager@comcast.net 717-507-0009
Goal: To provide Junior High Youth the opportunity to play competitive baseball.
Date: Saturday January 19, 2013
Time: 1-3 PM Walk in Time
Location:
- Jonestown Elementary School please navigate to the gymnasium along the South of the building.
Practice TBD Beginning in January
Background:
2013 Program :____ FY 2013 16-U (2013-14 Grads) 12-15 year olds
PLAYERS EMAIL ADDRESS:_______________________________
PARENTS NAME:________________________________________
PARENTS EMAIL ADDRESS:_______________________________
ADDRESS:______________________________________________
CITY:___________________STATE:______ ZIP:_______________
Cell PHONE: (________) ________________________________
HIGH SCHOOL:__________________________________________
BAT:______ THROW:_______ HEIGHT:_______ WEIGHT:_______
BIRTHDATE:____________ GRADUATION YEAR:_________
WAIVER/RELEASE FORM PARTICIPANTS NAME:________________________________________ I understand that a baseball tryout is an athletic activity. As an athletic activity, the above named participant is responsible for all health risks associated with the activity. I, the undersigned, release the Fredericksburg Legion from any and all liabilities concerning this activity and the athletic activities that will take place therein.
Finally, I/we agree that in the event of illness or injury to my son/daughter during a Legion baseball practice or tryout, I/we hereby give consent for the performance of such diagnostic, medical and/or surgical treatment on my child as may be deemed medically necessary in order to assure the safety of my child._______________________________ ___________________
SIGNATURE PARENT/GUARDIAN DATE
FAMILY PHYSICIAN & PHONE NUMBER: _______________________
EMERGENCY CONTACT PERSON: ______________________________
EMERGENCY TELEPHONE: ____________________________________
MEDICAL RESTRICTIONS: ____________________________________
Location:
- Jonestown Elementary School please navigate to the gymnasium along the South of the building.
Practice TBD Beginning in January
Background:
2013 Program :____ FY 2013 16-U (2013-14 Grads) 12-15 year olds
PLAYERS EMAIL ADDRESS:_______________________________
PARENTS NAME:________________________________________
PARENTS EMAIL ADDRESS:_______________________________
ADDRESS:______________________________________________
CITY:___________________STATE:______ ZIP:_______________
Cell PHONE: (________) ________________________________
HIGH SCHOOL:__________________________________________
BAT:______ THROW:_______ HEIGHT:_______ WEIGHT:_______
BIRTHDATE:____________ GRADUATION YEAR:_________
WAIVER/RELEASE FORM PARTICIPANTS NAME:________________________________________ I understand that a baseball tryout is an athletic activity. As an athletic activity, the above named participant is responsible for all health risks associated with the activity. I, the undersigned, release the Fredericksburg Legion from any and all liabilities concerning this activity and the athletic activities that will take place therein.
Finally, I/we agree that in the event of illness or injury to my son/daughter during a Legion baseball practice or tryout, I/we hereby give consent for the performance of such diagnostic, medical and/or surgical treatment on my child as may be deemed medically necessary in order to assure the safety of my child._______________________________ ___________________
SIGNATURE PARENT/GUARDIAN DATE
FAMILY PHYSICIAN & PHONE NUMBER: _______________________
EMERGENCY CONTACT PERSON: ______________________________
EMERGENCY TELEPHONE: ____________________________________
MEDICAL RESTRICTIONS: ____________________________________
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