2010
Air Liquide/Anchorage Bucs
FREE Week Long Youth Clinic: Ages 6 to 13
Receive Free Bucs T-Shirt and Young Bucs Season Pass
Name:
Birthdate:
Address:
Phone:
City, State,
Zip:
As a condition
of participation in the Anchorage Bucs Baseball Clinic(s), the undersigned,
as the authorized parent or guardian of
, agrees and insures the following: All injuries sustained in the course of
participation in the Anchorage Bucs Baseball Clinic shall be reported
immediately by the participate to his/her coach. It is understood that injuries may
occur. The undersigned waives all
claims against the Anchorage Bucs Baseball (including coaches, officials, and
officers), for injuries sustained from participation of the above named
participant in the aforementioned clinic.
This includes any claim asserted on behalf of the above-mentioned
individual.
Except as
otherwise noted, the undersigned insures the above named participant is in good
health and is fully able to participate in the clinic(s). All allergies and/or other maladies or
unusual problems (physical), are listed below. The management, officers, and coaches of
the Anchorage Bucs Baseball Club have my expressed written permission to
authorize medical/surgical treatment for
when recommended by
qualified physician as long as treatment is for clinic
injury. I give permission for my child to be photographed as part of his/her participation in Buc's Clinics. I understand these photos may be used for promotional purposes.
Parent or
Guardian Signature
Date
Please Print
Full Name
Daytime Phone
Address
City, State, Zip
Emergency
Contact Name/Phone #
Allergies and/or Medical Conditions
Physician’s
Name
Physician’s Phone Number
Clinics are
held at MULCAHY STADIUM (located on 16th between Gambell and “C”).
All Clinics
are 9:30 am until 12:00 pm.
Clinic Week: JUNE 14 thru June 18, 2010
For more
information, call the Bucs office at 561-2827.
YOU DO
NOT NEED TO PRE-REGISTER... just bring this form to the
ballpark!