Private Lesson Waiver

Parent or guardian, please read and complete this registration waiver form.

Step 1 of 2

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• Player's Name*
  FirstLast
• Player's Date of Birth*
• Address*
  Street AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZip Code
• Home Phone*
• Injuries or Medical Conditions

• Parent / Guardian Name*
  FirstLast
• Parent / Guardian Email*
  Enter EmailConfirm Email
• Parent's Cell Phone*
• Medical Consent & Release of Liability*
  • I, the undersigned parent/guardian of the individual named above, a minor, do hereby agree to allow him to participate in the Select program and authorize the program directors and/or instructors as Agents for the undersigned to consent to emergency medical treatment that may be deemed necessary by medical personnel. It is understood that baseball involves an element of risk and a possibility of accidents. I am aware of the inherent risks and I hereby assume responsibility for those risks. In addition, I understand that by signing this agreement, I hereby release and hold harmless Sammamish Baseball Academy, its directors or other representatives from any and all liability associated with any injury resulting from participant’s involvement in the activity. It is the responsibility of the participant to provide health and / or accident insurance for camp participants.
• Photography Release*
  • I give permission for images of my child captured through photos or video to be used by SBA in promotional materials.