Email Address of Player, Parent, or Guardian*
Players Birth Month and Day (for Birthday celebrations)
School or Program your player attends*
Does your player use equipment? Please tell us what type. Ex. wheelchair, stroller, crutches, etc.
RELEASE FORM: I give authorization to the above listed person to participate in The Miracle League of Union County. I know that participation in baseball may result in serious injuries, and protective equipment does not prevent all injuries to players, and I do hereby waive, release, absolve, indemnify, and agree to hold harmless The Miracle League of Union County, and their organizers, sponsors, agents, insurers, supervisors, participants, and volunteers from any claim arising out of any injury to my child whether the result of negligence or for any other cause. I hereby grant The Miracle League of Union County, its affiliates, franchises, and advertising and promotional agencies, and their agents, the irrevocable, unrestricted right to use, publish, display and distribute materials bearing my name, voice, likeness or any other identifiable representation of myself, my family members including my Miracle League of Union County player. These materials may appear in any form, style, color or medium whatsoever (including, without limitation, photographs, video tapes, films, sound recordings, software, drawings, prints, broadcast, internet and electronic media). I agree that all material containing any identifiable representation of me (including without limitation, all negatives, plates, and masters of photographs, files, prints, or tapes) shall be and remain the sole and exclusive property of The Miracle League of Union County. I hereby release and forever discharge The Miracle League of Union County from any and all liability and damages relating to the use of my name, voice, likeness or any other identifiable representation of me. I hereby waive any right I may have to inspect or approve the finished materials or any part or element thereof that incorporates my name, voice, likeness, or any other identifiable representations of myself, my family including my Miracle League of Union County player. I acknowledge that I have fully read and understand this document and that I have had any questions regarding its effect or the meaning of its terms answered to my satisfaction. I certify that I am a least 18 years of age, unless this document is also signed by my parent or legal guardian.
Player, Parent, or Guardian Electronic Signature*
I will pay $40 Registration fee by: