Registration Form

Players Name:………………………………………………………………………Age & Grad Year:……………………………………….

Street Address:…………………………………………………………………………………………………………………………………………..

City……………………………………………….. State:……………………………….. Zip Code:………………………………………………

E-Mail: ………………………………………………………………………………………………………………………………………………………..

Parent/Guardian Name: ……………………………………………. Cell Phone #:…………………………………………………….

Health Insurance Company: ………………………………………………………………………………………………………………….

Policy #: ……………………………………………………………………………………………………………………………………………………

Please specify which class attending…………………………………………………………………………………………………….

Total Amount: $…………………………..                     Payment Type:      Cash/ Debit/ Credit/ Check    (Circle)

Check #:…………………………………………………………..   Card #:………………………………………………………………………….

Expires: ………………………………   CVS # Code: ……………………

I herby register my child for the Diamond Pro NW Hitting Clinic and authorize the staff to direct her in participation of camp activities.  I know of no mental or physical problems that may affect her ability to safely participate in this clinic.  I authorize the camp staff to attend to any health problem or injury to my child that may occur while attending the clinic.  I hereby release and hold harmless the Diamond Pro NW hitting clinic, its employees, agents, and assigns from any liability that may rise from my child’s participation in the camp.  I acknowledge that I am responsible for any and all medical expenses due to my child’s illness or any injuries that occur at camp and that the Diamond Pro NW hitting clinic carries only accident insurance, which is secondary to my own insurance.  I authorize all medical, surgical, diagnostic and hospital procedures as may be performed or prescribed by a treating physician for my child if I cannot be reached in case of emergency.

 

Signature of Parent or Guardian: ……………………………………………………………………………………………………

 

Please Send Registration Form to:

Diamond Pro NW

20915 SW 105th Ave,  Suite A

Tualatin, OR 97062

***Checks payable to Diamond Pro NW***