Indian Valley Storm Player Information and Release Form
Player’s Data
Name:
Street Address:
Town:
Zip:
Township/County:
Email Address:
Home Phone:
Personal Information
Primary Parent Contact Name:
Home Phone
Medical Insurance #s
Players’ Date of Birth:
Jersey Size
Number Preference- (at least 3 choices)
Cell Phone for text messages:
Cell
Phone
Insurance Co
Group #
Phone #
Age:
Copy of Birth Certificate Must Be Attached
I, the Parent and/or Guardian of the above Player do hereby release Indian Valley Storm Baseball and its coaches and volunteers from the
liability for injury resulting from the playing and or practicing of baseball; I, the Parent and/or Guardian of the above player do hereby
understand that the playing of baseball is not without risk of injury (which could be serious). I, the Parent and/or Guardian of the above
Player do hereby certify that the player listed is physically capable to play baseball and has my (our) permission to play on the Storm
Baseball Team. In the event my Child is injured while participating in this program, and I am not available to take responsibility for
treatment, I authorize Storm Baseball to consent to any medical or dental treatment recommended by an appropriate medical or dental
professional and I agree to pay for any costs or expenses of treatment rendered pursuant to this authorization.
Parent/Guardian Signature:
Date: