Copy of Original REGISTRATION

CC Panthers Inc. Baseball/Softball Registration Form

Athlete Information

Player Name (First, Middle, Last)

Date of Birth

Parent/Guardian Name (First, Middle, Last)

If yes, Please list Name(s), Gender & Ages

Address

Phone

Name of School

Sport Application Information

Machine Pitch (Baseball & Softball)

Majors (Baseball & Softball)

Tee-ball (Co-ed)

Minors (Baseball & Softball)

Babe Ruth (Baseball & Softball)

Emergency Contact Information

Name of Emergency Contact(s) (First, Middle, Last)

Phone Number

Address

Relation ot Athlete

I hereby declare that I give my full express consent to let my child be given immediate treatment by any qualified medical personnel in circumstances which may need immediate attendance and care.

Medical Information

In case the parent/guardian is out of reach at the time of emergency, with consent of the latter, we will exercise the required diligence needed to have the athlete treated by an E.R Physician. In this regard, we would like to get to know any precautions that we need for the athlete.

Clinic/Hospital

Name of Family Doctor

Any Allergies to Medicine and Antibiotics?

Yes

If Yes, Please List Any Allergies to Medicine to Antibiotics:

Medical Diagnosis:

Medicine Taken

Dosage

Dosage/Frequency Taken

Parental/Guardian Consent

I am aware that any physical sport activity may cause accidental injury or harm among the athletes, and I assume any and all possible risk that may cause injury, illness, or death arising to such activity. I agree to waive my right to pursue any claim against the Commission and the Organizing Committee of this event.

Your Signature

Parent/Guardian Name(s)