Woburn Sox Youth Softball
REGISTRATION FORM

Players Name:_______________________________________DOB:__ __ __

Address:________________________________Phone: ______________

Emergency Contact: _________________________Phone: _____________

Family Physician:_______________________ Phone: __________________

Allergies:_________________________________________________________

Date of last TetanusBooster: _____________________________________

Medical Insurance Carrier: ___________________________________________

Policy #_______________________________________________________

In case of emergency, if family physician cannot be reached, I hereby authorize that _________________________may be treated by another available licensed physician.

Parent or Guardian_______________________________________

(Signature required)

EMAIL_________________________________________

I, (parent/guardian name printed)______________________, as parent and/or legal guardian of (participant’s name)______________________, in consideration of his/her acceptance and participating in the Woburn Sox Youth Softball League agree to waive, release and hold harmless the Woburn Sox Youth Softball League and the city of Woburn, their principals, agents, and employees, from any and all claims for the named participant, myself and my heirs for injuries or illness which may directly or indirectly result out of participation in said League. I understand that there are inherent risks of physical injury and/or illness associated with the sport of softball and do hereby acknowledge that I have read the above stated waiver and warning and accept its terms freely and voluntarily as explained above.

Parent/Guardian Signature_____________________________________