Name ____________________________________ Age______ Grade_______ Phone____________________

Email ____________________________________ Class registering for: _______________________________

I hereby request that you accept the application for enrollment of _________________________________ in the skills class listed above.  I understand that these workouts may be strenuous, and I hereby release Marc Wilkins Baseball Academy, instructors, and assistants from any claims on account of injury or illness which may be sustained while attending or participating in any classes. I also agree to hold harmless Marc Wilkins Baseball Academy, instructors and assistants for each claim which may heareafter be presented as a result of any such injury or illness. I also certify that this student is in good health and physically fit to participate in these skill classes.

Parent/Legal Guardian Signature: _________________________________________  Date_________________________                                                                         

Mail to:  MWBA

             4520 Snodgrass Road

             Mansfield, OH  44903