Player Name

Player Name _______________________________ School _________________________________ Grade _____ Address ______________________________________________ City _______________________ Zip ________ Phone _______________________ Email ___________________________________________ Emergency Contact __________________________________________ Phone __________________________ Saturday March 25, 2017 10:00am to 2:00pm Moshier Field #1 430 S 156th St, Burien, WA 98166 PLAYER FEE $10 Registration and Payment can be made at any Pacwest registration or Sent to 225 S 152nd St Burien, Wa 98148 Checks should be made payable to: HHS Booster Club – Baseball Bring: Mitt, baseball ready warm layered clothing and tennis shoes (baseball cleats optional)

Assumption of Risk/Permission to Participate

Medical Information

The following special health problems should be noted:

In the event of an emergency, I wish the following person to be notified in case I cannot be contacted:

Phone(s)

Although I understand that Highline School District will make reasonable effort to provide a safe environment, I am fully aware of the special dangers and risks inherent in participating in this activity, including physical injury and/or death. Being fully aware of the risks, I hereby give

permission for

to

participate in the 2016 Highline High School Baseball clinic, April 17, 2016, for the purpose of practicing fundamental baseball skills in order to enhance skill and performance level.

Parent/Guardian Name

Address

Parent/Guardian Signature

Phone(s)

Work Phone

________________________________________________________ Date__________________________