2017 Southwest Boys Club Fall Ball Player Registration
Player Name
Team
Coach
Divison
Fall 2017 Grade
Age
Date of Birth
Release and Waiver
I hereby authorize the directors, coaches and
agents of the organization and their affiliates of
Southwest Boys Club to act in behalf, using their
best judgement, in any emergency, including
medical emergencies. I hereby waive and release
the league, its employees, directors, sponsors,
suppliers, Play It Again Sports, Southwest Boys
Club and facilities from any liability of illness or
injury incurred while playing in the league. I
know of no mental or physical problems that
might adversely affect this participant's ability
to participate in the league.
Printed Name
Payments
Trx #
$55 Paid
Address
City, State, Zip
Phone #
Signature
Amount
Parents Name
Alternate Phone #
E-Mail Address
Date
Birth Cert.