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2012 NVLL All Star Baseball Clinic Registration

Please note that only residents of Vallejo California are eligable to attend the clinic. Spaces are available on a "first come - first serve" basis. Additionally, in the event of rain, a modified, indoor clinic will be held.

Division
 

Player Name
 

Parent's Name
 

Address
 

City / Zip
 

Phone
 

Age / School
 
/

T-shirt Size
 


PLAYER RELEASE AND WAIVER

I hereby forever release and discharge North Vallejo Little League Inc., The PitCCh In Foundation Inc., Greater Vallejo Recreation District, and their respective agents, affiliates, officers, directors, managers, employees, members, partners, shareholders and representatives from and against any and all liabilities, claims, demands or causes of action for any injury, illness, incident or damage (physical or otherwise) suffered by my child arising out of, or related to, my child's participation in the North Vallejo Little League All Star Clinic (the "NVLL Clinic"), including, without limitation, my child's travel to and from the event.

I hereby represent, warrant and covenant that I have no knowledge of any physical or mental impairment that would affect my child's participation in the clinic.

Further, I hereby authorize the NVLL staff to act in accordance with their best judgment in any emergency requiring medical attention.

Insurance Company
 

Policy Holder
 

PPO/PPN/HMO/EPO
 

Policy #
 

Group #
 

Physician's Name
 

Physician's Phone
 

Allergies
 

Medication/Dosages
 


EMERGENCY CONTACT

Name
 

Address
 

City / Zip
 

Home Phone
 

Work Phone
 

By clicking the button below, you agree to all terms contained in this form. You will be taken to the payment screen after submitting this form.