Mundelein Baseball & Softball Association - MBSA
Roster &Hold Harmless Waiver–2016MBSA Fall Baseball League
Team Name: ______Age Level: ______
Head Coach: ______Date: ______
So that there will be no misunderstandings, any player wishing to participate in the 2016 MBSA Fall Baseball League must have this waivercompleted by their parent(s) or legal guardian(s). A player will not be allowed to participate in any games until the waiver has been completed and signed and the coach/manager has turned in the signed waiver to the Tournament Director. Any player who falsifies their age/or their parent’s/ legal guardian’s signature(s) will forfeit for their entire team any games in which they participated in.
The information I have provided regarding my son/daughter is correct. I/We know that participation in baseball may result in serious injuries to my/our child. Protective equipment does not prevent all injuries to players. My son/daughter has my permission to participate fully in the 2016 MBSA Fall Baseball League games and practices. To the best of my knowledge, my son/daughter has no physical impairments or health conditions that might restrict his/her participation. I agree to indemnify, hold harmless, and release from all liability;Mundelein Park District, Fremont Township, MBSA, Inc., or any of their officers, directors, managers, coaches and staff members from all expenses or damages on account of any accidents, personal injury, death or loss of property sustained by my son/daughter as a result of his/her participation in the above activities, whether traveling to, while at, or traveling from Keith Mione (Mundelein) Community Park or Fremont Community Park (Ivanhoe Field).
We also understand that it is the responsibility of each team’s coach/manager to secure a liability insurance policy to cover the team with which our child/ward is playing with while participating in the 2016 MBSA Fall Baseball League.
If emergency treatment is necessary and parent/guardian are unavailable, I hereby give my permission for my child to be taken to the nearest doctor or hospital and agree to pay all fees in connection with such treatment or service.
Player Name / Uniform# / Player
Birthdate / Parent/Guardian Signature / Parent Phone / Date Signed
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The signatures above indicate that this waiver has been read, the contents understood, and was signed freely and voluntarily.