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Lebanon County Girls Fastpitch League
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If you would like any more info,
you can contact us at lcgfp@hotmail.com
Messiah One Day Clinic Form
2002 Falcon Softball One Day Softball Clinic
(Please Print)
Name : |
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Address : |
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City : |
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State : |
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Zip Code : |
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Age : |
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Grade : |
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Name of Parent/Guardian : |
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Phone : |
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Work Phone : |
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High School : |
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Coach : |
___________________________________ |
Position(s) : |
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Insurance Carrier of Athlete : |
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The student named above has my permission to participate in the designated Messiah College one day clinic. I understand that clinic participation may involve significant physical activity which could
result in injury. I certify that the child is in good physical condition
and is fully able to participate. I assume all risk incident to the
child's participation and release Messiah College, its employees, agents, officers, and volunteers from all liability, claims, expenses, and actions which may arise from injury or harm to the child as a result of clinic participation. In the event of a medical emergency, I authorize Messiah College to designate a physician or hospital or emergency personnel to provide medical care (including hospitalization, if necessary) to the child, and release Messiah College from any liability for injury or harm to the child which may result from this medical care. I understand that responsibility for payment for such medical care will be mine and certify that the child is covered by adequate medical insurance.
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Signature of Parent/Guardian : |
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Date : |
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Please include any significant history : |
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Please return with your deposit of $20.00 by February 1, 2002.
Send your deposit to:
Messiah College Softball
One College Ave
Grantham, PA 17027
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