The Miracle League of Lake Placid

2011

Buddy Under 18 Years

Registration Release Form

 

Buddy Name __________________________________________

 

Buddy Address _________________________________________

 

______________________________________________________

 

Buddy Phone # _________________________________________

 

Buddy E-mail __________________________________________

 

In consideration for The Miracle League of Lake Placid providing the opportunity for my child to participate in Miracle League baseball, the undersigned does hereby release and agree to indemnify and hold harmless The Miracle League of Lake Placid, it’s staff, officers and directors from any and all claims for personal injury, death, property damage, or any type of claim or damage (including but not limited to attorney’s fees or litigation expenses) resulting from my child’s activities in connection with participation in Miracle League baseball or the participation of any family member or guest of the undersigned.  I consent for my child to receive first aid and/or emergency medical care in the event of an injury.

 

I/We understand that there will be media and promotional coverage of The Miracle League of Lake Placid games and activities and I/We give our consent to publish my/our child’s name and picture for such purposes.

 

 

 

_________________________________________      ______________________________

Parent/Guardian Signature                                                                     Date Signed

 

 

Please sign and return to:

 

Adela Casey

Buddy Registration

441-0226 (cell) 465-7799 (fax)  buddyregistration@miracleleagueoflakeplacid.com