COMPLETE FORM AND BRING FORM & CHECK WITH YOU SUNDAY:
Please call if you would like to confirm a spot in the clinic
585-293-3215
(Checks payable to "Mercy Softball")

NAME __________________________________________________________

ADDRESS ______________________________________________________

PHONE _____________________________ GRADE ____________

Email Address:__________________________ (If you would like us to confirm your registration or reserve a spot for you)

3 / 5 / 2006 - (11 a.m. - 3p.m.)

CHECK ONE:
Hitting and fielding clinic only _____________

Both pitching/catching AND hitting/fielding clinics _____________

Level of experience (circle highest level played):

Varsity.............JV.............Modified......................CYO..............Little League..........Town Rec

RELEASE:
I, the parent or legal guardian of the above-named player, hereby give my permission for her participation in any and clinic activities. I assume all risks and hazards incidental to such participation and do hereby waive, release, absolve, indemnify and agree to hold harmless Our Lady of Mercy High School's softball team and coaches and Mercy High School from any legal responsibilities. I hereby authorize any physician and/or member of the medical staff at the school and any hospital/emergency treatment center to render emergency medical treatment which in his/her judgment is deemed necessary.

_______________________________________________ Date:_________________________
Signature of Parent/Legal Guardian

During the clinic, I can be reached at: ____________________________(phone #)

MercySoftball@aol.com