2021 Summer Uncommitted Workout Registration Form Player Name (First and Last)(required) Grad Year(required) Description of Jersey you will wear at Workout (Team, Color, Number)(required) Age (required) Grade (required) School(required) Summer Team(required) Choose Position for Workout: Primary Position $100 Pitcher Only $75 Two Way Player = Position Player + Pitcher $150 Two Way Player + Secondary Position (Workout at 2 positions + Pitcher) $175 Primary + Secondary = Workout at Two Positions (Non Pitching) $125 Primary Position (required) Secondary Position (only needed if working out at additional positions) Player Email Player Phone Number Parent Name(required) Parent Email(required) Parent Phone Number(required) Emergency Contact Person During Camp Hours (if different from Parent) Emergency Contact Phone Number Permission Slip/Parent Waiver I give my permission for my child to participate in Coach Encapera’s Baseball Camp. My child has had a recent physical exam and is physically able to participate in all clinic activities. I certify that my child has adequate medical insurance and I relieve the Directors of the clinic, the student helpers,the park owners, or municipality of any responsibilities or liability should any accidents occur. I give consent for the camp staff to treat my child in case of injury or illness. I also understand that any serious violation of camp regulations will result in removal of my child from camp and no refund will be given. I agree to the Permission Slip/Parent Waiver Terms WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19 I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY CHECKING THE BOX ON THE REGISTRATION FORM, AND ACKNOWLEDGE FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT In consideration of being allowed to participate on behalf of (Coach Encapera Baseball Camp) athletic program and related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS (Coach Encapera Baseball Camp) their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I agree to the terms of the COVID 19 Waiver How did you hear about us? Search Engine Social Media Newspaper Friend or Family CLICK HERE FIRST TO SUBMIT ONLINE REGISTRATION FORM Click Here AFTER Submitting Form to make Online Payment Share this:TwitterFacebookLike this:Like Loading...
