Hartford Baseball / Softball Association Registration Form Participant’s name_____________________________ DOB ________ Age ____ Shirt Size ____Preferred #_____ Parent’s or Guardian’s name ________________________________________________________________ Mailing Address ___________________________________________________________________________ Physical Address __________________________________________________________________________ Home Phone _____________________________________ Cell Phone _______________________________ Email address _____________________________________________________________________________ Emergency Contact ____________________________________ Emergency Phone ____________________ Please list any allergies or medical conditions:_____________________________________________________ Release: I am fully aware of the risk inherent and hereby give consent for the above named applicant to participate in the program offered by the Hartford Baseball/Softball Association, and hereby release the Hartford Baseball Softball Association (a private non-profit) and any of their elected or appointed officials or employees or instructors from any and all liability from injuries, claims, demands, costs, loss of service, expenses and/or damages which may be sustained by me or us or our minor children on account of his or her participation in said program or assorted activities and events. As a matter of caution, the Hartford Baseball/Softball Association strongly recommends that you have accident and health insurance in force when you take part in a Hartford Baseball/Softball Association program. Waiver: I hereby give consent for my child to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during as event. ________________________________________________________ Parent or legal Guardian signature if participant is under 18 ________________________________________________________ Participant if 18 or over 2013 Hartford Cal Ripken Summer Program Fees will be $150/ player. Completed registration forms w/ payment can be dropped off at the Hartford Recreation Department, mailed to HBSA PO Box 311 Wilder, VT 05088 or brought to first night of tryouts on Saturday, June 1 st .

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Hartford Baseball / Softball Association

Registration Form

Participant’s name_____________________________ DOB ________ Age ____ Shirt Size ____Preferred #_____

Parent’s or Guardian’s name ________________________________________________________________

Mailing Address ___________________________________________________________________________

Physical Address __________________________________________________________________________

Home Phone _____________________________________ Cell Phone _______________________________

Email address _____________________________________________________________________________

Emergency Contact ____________________________________ Emergency Phone ____________________

Please list any allergies or medical conditions:_____________________________________________________

Release: I am fully aware of the risk inherent and hereby give consent for the above named applicant to participate in the program offered by the Hartford Baseball/Softball Association, and hereby release the Hartford Baseball Softball Association (a private non-profit) and any of their elected or appointed officials or employees or instructors from any and all liability from injuries, claims, demands, costs, loss of service, expenses and/or damages which may be sustained by me or us or our minor children on account of his or her participation in said program or assorted activities and events. As a matter of caution, the Hartford Baseball/Softball Association strongly recommends that you have accident and health insurance in force when you take part in a Hartford Baseball/Softball Association program. Waiver: I hereby give consent for my child to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during as event. ________________________________________________________ Parent or legal Guardian signature if participant is under 18

________________________________________________________ Participant if 18 or over

2013 Hartford Cal Ripken Summer Program Fees will be $150/ player. Completed registration forms w/ payment can be dropped off at the Hartford Recreation Department, mailed to HBSA PO Box 311 Wilder, VT 05088 or brought to first night of tryouts on Saturday, June 1st.