Player Info *

First Name

Last Name

Birthdate *

MM

DD

YYYY

PARENT/GUARDIAN #1 *

First Name

Last Name

Phone *

(###)

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PARENT/GUARDIAN #2 *

First Name

Last Name

Phone *

(###)

###

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MEDICAL/EMERGENCY CONTACT INFORMATION *

First Name

Last Name

Phone

(###)

###

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WAIVER INFORMATION

By my clicking below, I hereby certify that, to the best of my knowledge, I am physically fit to participate in Snohomish Shock Softball for this academic year. I do not suffer from any condition that would increase the possibility of injury during participation. I understand that the Snohomish Shock Softball Staff may invalidate this form. I further agree to inform the Manager(s) if my physical condition changes to the degree to prohibit participation within 12 months from the date of this form. Snohomish Shock Softball carries insurance minimum to cover treatment for injuries that may be sustained in any Snohomish Shock Softball program. I understand that I am encouraged to obtain insurance coverage before participating in any activity. I waive Snohomish Shock Softball and its volunteers for any and all injuries and damages that I may suffer through my participation in Snohomish Shock Softball activities, whether caused by the negligence of Snohomish Shock Softball, its volunteers, or otherwise. I have read this release and intend to be legally bound by it.

I/We agree with the above *Required