East Cobb Patriots Academic ShowcaseSponsored by Opportunities for Kids, lnc.

Please Return This Form To:

fim LoveioyOpportunities for Kids, Inc.PO Box 723893Atlanta, GA 31139

$250 Check Payable to Opportunities for Kids,Inc.The ofthe Event

Participant's Personal lnformation

Participant's First Name

Participant's Last Name

Preferred Name Participant Uses

Rising Grade High School Grad YearChoose grade level ofthe participant for the upcoming school year.

Participant's Street Address

City, State Zip

Home Phone Participant's Cell

Participant's Email Address

Father's EmailAddress

Mother's EmailAddress

Name of School Participant Attends

Height Weight

Jersey Size (Please Circle) S M L

Please Note: lf you have not yet token the SAT or ACf, SKIP this section.

SAT Reading Score

ACT Composite Score

SAT Math Score

XL

Page 2

What Is Your Grade Point Average?

Is this Grade PointAverage Out Of a Possiblw 4.0 Maximum Grade? Yes

- No

Is ThisAWeighted Grade PointAverage? Yes No

Is This Participant Traveling Alone or Without A Parent/Guardian To This Event?

Yes _ No

Athletic Refe re nc e Information

Baseball Primary Position

Baseball Secondary Position

High School Coach's Name

Cell Number Email Address

Summer Team's Name

Summer Coach's Name

Cell Number Email Address

I hereby request and grant permission to the instructors and offtcials of Opportunities for Kids and East Cobb Patriots Academic

Showcase to provide care to my child in the event of injury or illness if I am not present. Such care may include but shall not

be limited to, first aid treatmen! transporting to a medical facility or the summoning of emergency assistance. I, the undersigned

parent or appointed guardian of the above named child, do hereby agree to indemnify and hold harmless Opportunities for Kid, Inc.

and East Cobb Baseball, Inc and its officials, managers, coaches and assistants from all liability for the above named child's activities

of any nature with said associations. I acknowledge that participation in this Showcase and related activities involves an inherent

risk ofphysical injury, and on behalfofthe registrant, hereby assume all such risk and do hereby release and forever discharge

Opportunities for Kids, Inc. and East Cobb Baseball, Inc. and all agents thereof from any and all liability of whatever kind of nature,

arising from and by reason ofany and all known and unknown, foreseen and unforeseen, bodily and personal injuries, damage to

property, and the consequences thereof, resulting from this registrant's participation in or involvment with this Showcase, including

any failure of equipment or defect on or in the premises.

SIGNATURE OF PARENT / GUARDIAN

Relationship

Date