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Canes Medical Release Waiver

Student-Athlete Information

Player Name

First Name

Last Name

Player Twitter Handle

@

Team/Age Group

Player DOB

MM

DD

YYYY

Projected Graduation Year

Jersey Size

Please Indicate between Youth or Adult Sizes

Top 8 Jersey Numbers

These are not guaranteed to be available, but we will try our best to honor your requests.

Additional Information

Earliest I Can Make Practice

4:30 PM

5:30 PM

6:30 PM

7:30 PM

I am UNAVAILABLE of these days:

Parent Contact Information

Primary Email Address

Primary Phone Number

(###)

###

####

Secondary Email Address

Secondary Phone Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

PARENT/GUARDIAN AGREEMENT

I/WE HAVE READ THE BELOW AGREEMENT AND UNDERSTAND THAT I/WE GIVE UP CERTAIN RIGHTS BY VOLUNTARILY SIGNING THIS FORM. BY CHECKING THIS BOX, I AM ALSO CONFIRMING THE USE OF THE PROVIDING BILLING INFORMATION IN REGARDS TO THE AGREED UPON PAYMENT STRUCTURE DISCUSSED.

I/WE UNDERSTAND THAT PHOTOS & VIDEOS TAKEN BY THE CANES ORGANIZATION ARE SUBJECT TO USE ON SOCIAL MEDIA AND FOR MARKETING PURPOSES

I/WE ARE COMMITTING TO THE CANES SOUTHWEST ORGANIZATION FOR THE SEASON, AND AGREE TO FOLLOW ALL GUIDELINES PRESENTED BY THE ORGANIZATION.

Medical /Liability Release Form

I/We the parents of the above named candidate for a position on a Canes Southwest Select Baseball Team hereby give our approval to participate in any and all Canes activities, training, and practice sessions.

I/We know the participation in baseball may result in serious injury and protective equipment does not prevent injuries to players, and do hereby waive, release, absolve indemnify and agree to hold harmless Canes Southwest LLC, Its Directors, owners, landlords, agents organizers, sponsors, instructors, supervisors or affiliates as well as any participants from any claims arising out of injury to my/our child whether the result of negligence or for any other cause, except to the extent and in the amount covered by accident or liability insurance. I understand that baseball is a dangerous sport and assume all risks associated with practicing at the Canes Southwest program. I affirm that my child is in good physical condition and covered by health accident insurance independently.

As a parent and or guardian I hereby give my permission for the participant to be transported for emergency medical care. I also hereby consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions necessary to preserve life, limb or well being of my dependent.

Please complete and sign the above form to agree to your participation in the Season for the Canes Southwest.