Text Box: NARROWS BASEBALL CLUB 3110 Judson St. PMB # 189 Gig Harbor, Washington 98332 E-Mail: narrowsbaseballclub@yahoo.com A 501(c (3) Non-Profit Organization (EIN: 20-0423069) REGISTRATION & RELEASE Name: Date of Birth: / / Address: City/State/ZIP: / / Home phone: ( ) and/or ( ) Cell phone: ( ) and/or ( ) E-Mail: Emergency Contacts: Name(s) & Phone Number(s) and relationship to player: Physician: Phone: ( ) Insurance Provider: Member/ID # LIABILITY RELEASE: I/We hereby waive, release and discharge any/all claims for damages due to death, personal injury and/or property damage which I/We may have or which may hereafter accrue as a result of participation. This release is intended to discharge, in advance, NARROWS BASEBALL CLUB, its ownership and/or employees, partners, officials, agents and representatives, even though liability may arise out of negligence or carelessness by persons/entities listed. I/We realize that baseball can be a potentially dangerous sport, played with a hard ball that is hit and/or can be thrown at high speeds. This is a sport where injuries are fairly common. It is understood that activities may involve an element of risk for injuries and, knowing those potentials, I/We hereby assume said risks. It is further understood and agreed that this waiver, release and assumption of risk is binding on any/all heirs and assigns. CONSENT TO TREAT: I/We hereby give consent to treatment by a Physician, Surgeon or other qualified person in case of sudden illness or injury. I/We understand that the NARROWS BASEBALL CLUB provides only supplemental medical insurance. Any treatment and the cost thereof will be at my expense. The location of the activities or nature of the illness may require use of medical emergency personnel. MINOR CHILD RELEASE (If Applicable): I give my permission and consent for my minor child named above to participate in the activities of the NARROWS BASEBALL CLUB, execute the above Liability Release and Consent to the Treatment of my minor child in case of a sudden illness or injury by a Physician, Surgeon or other qualified person. Is the participant allergic to any medication? Yes___No___ If yes, please list below: Does the participant have any medical conditions of which the Narrows Baseball Club should be aware? Yes__ No___ If yes, please describe below: I have read & understand the foregoing information and agree to all of the above: Parent: Print Name Participant: Print Name