STATE FAIR COMMUNITY COLLEGE

SOFTBALL CAMPREGISTRATION/CONSENT FORMJuly 15-17, 2019 | Centennial Park-Mandy Thomas FieldPlayer Information

Name ______________________________________________ Date of Birth __________________________

Address ____________________________________________________________________________________

Email address ______________________________________________________________________________

Grade (going into) ______________________________School attending __________________________

Favorite position(s) __________________________________________________________________________

Shirt size (circle one)

Youth sizes | Small Medium Large Adult sizes | Small Medium Large XL

Parent Information

Name _____________________________________ Email __________________________________________

Address ____________________________________________________________________________________

Cell phone __________________________ Home phone __________________________________________

Emergency ContactName ______________________________Relation _______________________________________________Contact phone (s) ___________________________________________________________________________Medical insurance provider _______________________________Policy # _________________________ Known allergies ____________________________ Date of last tetnus shot _______________________ Additional information ______________________________________________________________________

I, the undersigned parent or legal guardian of the above-named minor do hereby consent and agree that the above-named minor may participate in the SFCC Softball Camp. It is agreed that the named college, board members, and officials assume no legal liability for injuries or other loss as a result of said participation. It is further agreed that this consent shall remain in full force and effect until such time as the undersigned parent or legal guardian shall notify the college in writing of the subrogation or cancellation of this consent.

I hereby certify that the SFCC Softball Camp staff has full and unconditional authority to proceed with diagnosis and treatment as judgment indicates for injuries during camp. The SFCC Softball Camp shall not be held responsible for any consequences resulting from injuries.

I declare that I am the (circle one) Father/Mother/Guardian of the above-named minor.

_________________________________________ ___________ Undersigned – Print Name Date

_____________________________________________________Signature

PLEASE MAKE CHECKS PAYABLE TO: SFCC SOFTBALL CAMP

ENROLL ONLINE | sfccmoroadrunners.comor mail | bring this form to

State Fair Community CollegeFred E. Davis Multipurpose Center

ATTN: Lyndsey Talbot, Head Softball Coach3201 W. 16th St. Sedalia MO 65301

SFCC is an equal opportunity institution and is smoke and tobacco-free. Visit sfccmo.edu to learn more.