East Side Baseball Association

VSI Baseball & Coach Preston Peavy

Medical Release, Indemnification & Participation Agreement

To assure that VSI Baseball play & instruction promotes player safety, skills development & enjoyment & to avoid disruption for other participants we require this section be completed:

Player’s Name: Birth Date ______

______

For & in consideration of allowing my child to participate in the athletic program of VSI Baseball with Coach Preston Peavy (hereafter known as “VSI Baseball”), I, the undersigned parent or guardian of the above-named child (hereafter known as “my child”, agree to the terms & conditions below:

I hereby request & grant permission to coaches, assistant coaches, & other officials of VSI Baseball to provide reasonable care to my child in the event of injury or illness during any team activity if I am not present. Such care may include first aid treatment, transport to a medical facility or the summoning of emergency assistance (ambulance, rescue, etc.). I accept all financial liabilities resulting from such care.

I warrant that, in the space that follows, I have provided a listing of all relevant medical conditions, physical limitations, ongoing medications, & past injuries related to my child. ______I warrant that I have consulted reliable medical authorities about any conditions, limitations, medications, & injuries above & that these do not constitute a barrier to my child’s participation in a VSI Baseball athletic program.

I indemnify & hold harmless VSI Baseball, Coach Preston Peavy, officials, coaches, assistants & training locations from all liability from my child’s activities of any nature with VSI Baseball, Coach Preston Peavy & any facilities at which the events are held.

I understand that my child’s participation in lessons, practices & games is essential to his/her development & enjoyment & that of other players & parents on my as well. I promise to ensure my child’s attendance & attention at lessons, practices & games &, when possible, to provide all VSI Baseball coaches, assistant coaches & other officials of Page 2 of 2

VSI Baseball with advance notice of absences. Unexcused absences from lessons will be charged & paid for at the normal lesson rates.

I understand that VSI Baseball & Coach Preston Peavy requires prepayment to maintain a time account for lessons with a positive balance to book & calendar events. This ensures attendance & full consideration in booking/scheduling & helps lower hourly costs for clients.

I understand that VSI Baseball & Coach Preston Peavy often offer discounted group training purchases &/or team training costs that MUST be used within 6 calendar months of original purchase or they become void. Scheduling is subject to VSI Baseball & Coach Preston Peavy scheduling & availability. I further understand that these group instruction purchases are NOT refundable, but are occasionally transferable. This transfer is up to the sole discretion of VSI Baseball & Coach Preston Peavy.

I also agree to abide by VSI Baseball rules, including adult conduct expectations.

______Signature of Parent or Guardian Date

______Printed Name of Parent or Guardian

______Address

______City, State, ZIP

______/______/______Home Phone Cell Phone Work Phone

email address 1______

email address 2______

VSI Baseball & Coach Preston Peavy 4460 Bishop Lake Road Marietta, Ga. 30062 [email protected] 404-909-8020 404-402-5843 cell