Baseball Clinic Registration

Email^*

Enter email again^*

Parent/Guardian's Full Name:^*

Mailing Address:^*

Street Number

Street Address

City

State

Country

Zip Code

Parent/Guardian's Contact Number:^*

Child's Full Name:^*

Child's Date Of Birth:^*

Child's Gender:^*

Child's Grade While Participating In the Program:^*

Emergency Contact's Full Name:^*

Emergency Contact's Number:^*

Emergency Contact's Relationship to Child:^*

Is this child allergic to any medications?

Does this child have any medical history that you feel we should know about?

Consent and Release:^*

My child/legal ward has permission to participate in Premier Athletics for Youth Development programs. I hereby release and wave any and all claims against Premier Athletics for Youth Development and any agents, representatives, officers, board of directors, coaches, and other personnel of the same; from any responsibility of liability or liability for any injury, loss or damage which may hereafter be suffered or sustained by my child arising out of their playing or participating in this program. This includes but is not limited to competing in sports, traveling to or from any games/events, practice, or activities sponsored by Premier Athletics for Youth Development or while a spectator at any games, practices, or events. I authorize the head coach of my child’s team, Premier Athletics for Youth Development staff, or emergency personal to seek and/or provide medical attention for my child if I cannot be contacted.

I have read and accept the terms within the consent and release.

Model Photo Release:^*

I, for good and valuable consideration, the receipt of which is hereby acknowledged, hereby irrevocably authorize Premier Athletics for Youth Development to use photographs of me, my child, and/or my property and authorize their assignees, licensees, legal representatives and transferees to use and publish (with or without me or my child’s name, company name, or with fictitious name) photographs, pictures, portraits or images herein described in any or all forms and media and in all manners including composite images or distorted representations, and the purposes of publicity, illustration, commercial art, advertising, publishing (including publishing in electronic form in DVDs or internet websites), for any product or services, or other lawful uses as may be determined by Premier Athletics for Youth Development. I further waive any and all rights to review or approve any uses of the images, any written copy or finished product. I am of full legal age and have read and fully understand the terms of this release. I am the parent or guardian of the minor named above. I have the legal rights to consent to and do consent to the terms and conditions of this model release.

I have read and accept the terms of the Model Photo Release.

Assumption of Risk COVID-19:^*

By completing and signing this Agreement, I acknowledge the contagious and evolving nature of COVID-19 and voluntarily assume the risk that I, my children and/or my family may be exposed to and infected with COVID-19 while participating in PREMIER ATHLETICS FOR YOUTH DEVELOPMENT sponsored activities and that such exposure or infection may result in illness, personal injury, permanent disability, and/or death. I also understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, PREMIER ATHLETICS FOR YOUTH DEVELOPMENT employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any damage resulting from exposure to COVID19 (including, but not limited to illness, personal injury, disability, and/or death) to myself, my children and my family. I understand that any time a participant or parent feels like the risk is too great to the participant or participant’s family, the participant and/or parent may decide to leave or not attend the PREMIER ATHLETICS FOR YOUTH DEVELOPMENT sponsored activity. I hereby release, covenant not to sue, discharge, and hold harmless PREMIER ATHLETICS FOR YOUTH DEVELOPMENT and its officers, directors, agents, and representatives, of and from any claims arising out of my, my children and/or my family’s exposure to COVID-19, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of PREMIER ATHLETICS FOR YOUTH DEVELOPMENT and its officers, directors, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in PREMIER ATHLETICS FOR YOUTH DEVELOPMENT sponsored activities. By checking this Agreement, I also agree to ensure that I and my family understand and will follow all of the precautions put in place by federal, state and local government agencies as well as PREMIER ATHLETICS FOR YOUTH DEVELOPMENT and its host facilities.

I have read and accept the terms within the Assumption of Risk COVID-19 policy.