Forms

           Hitting League

                                 Registration Form

Name:_____________________________________

Address:_________________________________________

City & Zip:___________________________________

Home phone:_____________________________________

Parents’/Guardians’ Names__________________________

Emergency contact name & phone:

            ____________________________________________

School: __________________________________________

Grade:_________________    Birth date:_________________

Please list any medical issues we should be aware of:________________________________

___________________________________________________________________________

By enrolling at the Marc Wilkins Baseball Academy, participant understands that he/she attending the programs and using Marc Wilkins Baseball Academy and the facilities does so at his/her own risk. Marc Wilkins Baseball Academy and its owners, employees or agents, shall not be liable for any damage whatsoever arising from any personal injury or property loss sustained by participant with his/her family in or about any programs on the premises. Participants and parents assume full responsibility for all injuries and damages which occur in or about any programs on the premises, He/She does hereby fully and forever release discharged hold harmless Marc Wilkins Baseball Academy, all associated facilities and its owner, employees, and agents from any and all claims, demands, damages or rights of action, present or future resulting from any person’s participation in any programs or use of the facility. In addition, he/she agree(s) to follow the rules of conduct and play set by Marc Wilkins Baseball Academy. Failure to do so may result in suspension from participation. Consent: I the undersigned parent or guardian/participant do hereby grant authority to the staff at Marc Wilkins Baseball Academy to render a judgment concerning medical assistance or hospital care in the event of an accident or illness during my absence. I do hereby authorize Marc Wilkins Baseball Academy and its assigns to utilize any and all photographs, pictures or other likeness of me or anyone assigned guardianship to me, as they deem appropriate in its promotional materials or team films.

Parent/Guardian Signature:________________________________________

Date:_______________

Please mail completed form and check to: MWBA

                                                                           4520 Snodgrass Rd.

                                                                           Mansfield, OH  44903      Note any players who need to play together on back.