Release Form CFABA Family Physician: __________________________ Physician’s Phone: ________________________ Baseball I have Medical/Accident Insurance with: ________________________________ Skills Clinic Policy Number(s): _________________________ List names and phone numbers of persons who can be contacted during the day in the event of an injury requiring emergency medical treatment: 1. ______________________________________ 2. ______________________________________ 3. ______________________________________ I hereby certify that my child is in good physical health and may participate in all camp activities. I will not hold the Baseball Skills Clinic, CFABA, or the City of Cuyahoga Falls responsible in the event of an Sundays, accident or injury as a result of their participation. I also give permission for my child to be given emergency treatment at a local hospital. February 10- March 24 (12-4pm) __________________________________________ Signature of Parent/Guardian CUYAHOGA FALLS NATATORIUM Date: _______________ 2345 Fourth St • Cuyahoga Falls, OH 44221 What The objectives of the program are to instill in the players good Registration Form sportsmanship, honesty, courage, and responsibility as well as learn to play the game of baseball. Send check & Cuy. Falls Amateur Baseball registration to: Attn: Baseball Skills Clinic The clinic will emphasize on the fundamentals of throwing and P.O. Box 3563 catching, fielding techniques, and infield/outfield drills. Cuyahoga Falls OH 44223 Who Registration Fee: $50 per participant The clinic is for all kids ages 6-12 (TB, CP, H, & G Leagues) Cash and check accepted. Credit cards allowed at CFABA registrations & the first day of the clinic. When Make checks payable to: CFABA Sundays: February 10, 17, 24, March 3, 10, 17, 24 from 12 to 4pm (Registration is NOT complete until fee is paid) (times to be determined by players registered; time slots will be Please complete the form below, and sign and complete sent via email on February 9) the “Release Form” on the reverse side. Each participant **Please arrive 20 minutes early on the first day of the clinic requires their own form. (Sunday, February 10) for attendance & registration purposes. Please arrive 5-10 minutes early for the remaining clinic days. Name: ___________________________________ Where Natatorium Aux Gym Parent’s Name(s): _________________________ *participants are not required to have a Natatorium membership* Address: _________________________________ Registration City: ________________________ Zip: ________ Please mail the registration and release form attached to the address indicated with the $50 fee (cash or check). Registration Primary Phone: ___________________________ may be turned in at each CFABA registration (1/26, 2/9) as well as the first day of the clinic, Sunday, February 10. Secondary Phone: _________________________ Dress Attire Email: ___________________________________ Acceptable clothing includes sweats, t-shirts, track suits, sneakers, and baseball attire, including baseball caps. Please School: __________________________________ bring your own glove. NO CLEATS ALLOWED. Questions? Please contact either Mike DeSessa at (440) 227- Age: _____ League To Play This Year: _______ 9524 or Rich Dalman at (440) 759-0884 .