Central Valley Swarm

Registration Form 2015

PLAYER INFORMATION: AGE GROUP: ______

Primary Position:______Throws: Right or Left Bats: Right or Left

Secondary Position:______Other Position(s):______

Are you a slap hitter? ______If pitcher, what pitches do you throw? ______

FIRST NAME: ______LAST NAME: ______DATE OF BIRTH: ______

ADDRESS: ______HOME PHONE: ______

CELL PHONE:______SCHOOL ATTEND:______

GRADE: ______GPA:______MOST RECENT TEAM: ______

DO YOU PLAY ANY OTHER COMPETITIVE SPORTS OR REC SPORTS OTHER THAN SOFTBALL? IF SO WHAT SPORT?

______

DO YOU PLAY THE ABOVE SPORTS MENTIONED DURING THE SPRING/SUMMER FROM MARCH THRU JULY? ______

IF SO WHAT SPORT? ______IS IT COMPETITIVE OR REC SPORT? ______

PARENT/GUARDIAN INFORMATION:

MAIN CONTACT: FIRST NAME: ______LAST NAME: ______

HOME PHONE: ______CELL PHONE: ______EMAIL: ______

SECONDARY CONTACT: FIRST NAME: ______LAST NAME: ______

HOME PHONE: ______CELL PHONE: ______EMAIL:______

ACKNOWLEDGEMENT/RELEASE:

I/We acknowledge that membership in Central Valley Swarm organization includes expectation of parent/guardian involvement in fundraising (raffle ticket sales and/or corporate sponsors) for the organization. Once selected for a team, further information will be provided to me regarding expectations and organizational rules/guidelines.

I/We, the undersigned parent or legal guardian of the above named minor hereby authorizes the coach or any other official of the Central Valley Swarm to seek during the period of registration appropriate medical attention for the minor and for the medical attention to be given and for the minor to receive medical attention in the event of accident, injury or illness. The foregoing consent or authorization shall be valid only in a situation where a parent or legal guardian of the above named minor is not reasonably available to provide the necessary consent to medical treatment. I/We the undersigned parent or legal guardian, will release, indemnify and hold harmless Central Valley Swarm Softball (Mike and/or Larine Miranda), and its officers, directors, agents, and corporate sponsors from and against any liability of any kind arising out of the activities of Central Valley Swarm Softball.

Signature (Parent or Legal Guardian): ______Date: ______

PLEASE SEND THIS FORM TO: FAX (209) 669-8688 or EMAIL:

If any questions, please send questions to the above email address…..Thank you!