Baseball Clinic Week Dates: June 14 thru June 18, 2010. 9:30am till 12:00pm at MULCAHY STADIUM
Click Here To Print This Form

Air Liquide/Bucs Baseball Clinics bucstiny.gif - 3153 Bytes logoairliquide (2K)

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!